Incorporation of health technologies in the National Supplementary Health Agency: an analysis from the perspective of the advocacy coalition framework (2007–2016)

Antônio Sérgio Araújo Fernandes, Alana Mendonça Amorim
DOI: https://doi.org/10.21529/RECADM.2025002

Abstract

The work is a study on the policy of incorporating technologies in supplementary health, based on the update of the list of procedures and health events at the National Health Agency, from 2007 to 2016, based on the advocacy coalition framework. The work was developed from public document analysis in the minutes of agency meetings. The results show that the policy of incorporating technologies in the supplementary health system has several political actors with different interests and many of them conflicting. In this range of actors, two coalitions are identified: doctors and health insurances, here identified as welfare and liberal respectively. The work concludes that the welfare coalition was more successful in its political defense, possibly due to a convergence of values with agency guidelines.


Keywords

National Supplementary Health Agency; incorporation of health technologies; advocacy coalition framework

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References


Agência Nacional de Saúde Suplementar (2021a). Histórico.https://www.gov.br/ans/pt-br/acesso-a-informacao/institucional/quem-somos-1/historico

Agência Nacional de Saúde Suplementar (2021b). Cosaúde – Comitê permanente de regulação da atenção à saúde. https://www.gov.br/ans/pt-br/acesso-a-informacao/participacao-da-sociedade/comites-e-comissoes-1/cosaude-comite-permanente-de-regulacao-da-atencao-a-saude

Agência Nacional de Saúde Suplementar. (2023, 9 de julho). https://www.ans.gov.br/images/stories/Materiais_para_pesquisa/Perfil_setor/sala-de-situacao.html

Andrade, M. V., Noronha, K., Sa, E. B., Piola, S., Vieira, F. S., Vieira, R. S., & Benevides, R. (2018). Desafios do sistema de saúde brasileiro. Desafios da nação: artigos de apoio, 2, 357–414. Ipea.

Araújo, S. M. V. G. (2007). Coalizões de advocacia na formulação da política nacional de biodiversidade e florestas. [Dissertação de Mestrado, Instituto de Ciências Políticas, Universidade de Brasília. Repositório UnB. http://repositorio.unb.br/handle/10482/5756

Araújo, S. M. V. G. (2013). Política ambiental no Brasil no período 1992-2012: um estudo comparado das agendas verde e marrom. [Tese de Doutorado, Instituto de Ciências Políticas, Universidade de Brasília]. Repositório UnB. http://repositorio.unb.br/handle/10482/14599

Baird, M. F. (2017). Redes de influência, burocracia, política e negócios na Agência Nacional de Saúde Suplementar (ANS). [Tese de Doutorado, Faculdade de Filosofia, Letras e Ciências Humanas, Universidade de São Paulo]. Biblioteca Digital USP. https://doi.org/10.11606/T.8.2017.tde-01082017-182440

Capano, G. (2009). Understanding policy change as an epistemological and theoretical problem. Journal of Comparative Policy Analysis: Research and Practice, 11(1), 7–31. https://doi.org/10.1080/13876980802648284

Capelari, M. G. M., Araújo, S. M. V. G., & Calmon, P. C. P. (2015). Advocacy coalition framework: Um balanço das pesquisas nacionais. Administração Pública e Gestão Social, 7(2), 91–99. https://doi.org/10.21118/apgs.v7i2.4637

Guerra, L. C. B., Araújo, S. M., & Fernandes, A. S. A. (2016). O processo de formulação do programa universidade para todos: Atores, coalizões e interesses. Anais do Encontro de Administração Pública e Governança. 7 São Paulo. https://repositorio.ufrn.br/handle/123456789/20223

Jenkins-Smith, H. C., & Sabatier, P. A. (1993). Methodological appendix: measuring longitudinal change in elite beliefs using content analysis of public documents. In P. A. Sabatier, & H. C. Jenkins-Smith (Eds.), Policy change and learning: An advocacy coalition approach, 237–247. Westview Press.

Jenkins-Smith, H. C., Nohrstedt, D., Weible, C. M., & Sabatier, P. A. (2014). Advocacy coalition framework: Foundations evolution ongoing research. In P.A. Sabatier, & C. M. Weible (Eds.). Theories of the Policy Process (3a ed), 183–224. Westview Press.

Lisboa, R., Caetano, R. (2020). Avaliação de tecnologias em saúde na saúde suplementar brasileira: Revisão de escopo e análise documental. Saúde em Debate, 44(127), 1255–1276. https://doi.org/10.1590/0103-1104202012723

Mahoney, J., & Thelen, K. (2010). A theory of gradual institutional change. In: Explaining institutional change: Ambiguity, agency and power (pp. 1-37). Cambridge University Press.

Ma, J., & Vieira, D. M. (2020). Aprendizado e mudança em políticas públicas: Explorando possibilidades no Modelo de Coalizões de Defesa. Revista de Administração Pública, 54(6), 1672–1690.

Ma, J. F., Lemos, M. A. C., & Vieira, D. M. (2019). How’s the Advocacy Coalition Framework Doing? Some Issues since the 2014 Agenda. Anais do Seminários em Administração, 12. São Paulo. Recebido em 18 març.2020.http://login.semead.com.br/22semead/anais/arquivos/770.pdf

Ocké-Reis, C. O. (2012). SUS: O desafio de ser único. FioCruz.

Oliveira, H. C., & Sanches Filho, A. (2022). Uma breve trajetória dos elementos constitutivos do Advocacy Coalition Framework (ACF). Revista de Administração Pública, 56(5), 632–653. https://doi.org/10.1590/0034-761220220049

Pierce, J. J., Peterson, H. L., Jones, M. D., Garrard, S. P., Vu, T. (2017). There and back again: A tale of the advocacy coalition framework. Policy Studies Journal, 45(S1), S13–S46. https://doi.org/10.1111/psj.12197

Rebrats. (2023, 18 de junho). A Rede Brasileira de Avaliação de Tecnologias em Saúde – Rebrats. https://rebrats.saude.gov.br/quem-somos

Sabatier, P. A. (1998). The advocacy coalition framework: Revisions and relevance for Europe. Journal of Europe Public Policy, 5(1), 98–130.

Sabatier, P. A., & Jenkins-Smith, H. C. (1993a). The advocacy coalition framework: An assessment, revisions, and implications for scholars and practioners. In P. A. Sabatier, & H. C. Jenkins-Smith (Eds.), Policy change and learning: An advocay coalition approach, 211–235). Western Press.

Sabatier, P. A. & Jenkins-Smith, H. C. (1993b). The dynamics of policy-oriented learning. In: H. C. Jenkins-Smith (Ed.), Policy change and learning: an advocacy coalition approach, 41–56. Westview Press.

Sabatier, P. A., & Jenkins-Smith, H. C. (1999). The advocacy coalition framework: An assessment. In P. A. Sabatier (Ed.), Theories of the Policy Process, 117–166. Westview Press.

Sabatier, P. A., & Weible, C. M. (2007). The advocacy coalition framework: Innovations and clarifications. In P. A. Sabatier (Ed.), Handbook on Policy, Process and Governing, 189–220. Westview Press.

Vicente, V. M. B. (2015). A análise de políticas públicas na perspectiva do modelo de coalizões de defesa. Revista Políticas Públicas, 19(1), 77–90. https://doi.org/10.18764/2178-2865.v19n1p77-90

Weible, C. M., Sabatier, P. A., Jenkins-Smith, H. C., Nohrstedt, D., Henry, A. D., & deLeon, P. (2011). A quarter century of the advocacy coalition framework: An Introduction to the Special Issue. Policy Studies Journal, 39(3), 349–360. https://doi.org/10.1111/j.1541-0072.2011.00412.x

Weible, C. M., Ingold, K., Nohrstedt, D., Henry, A. D., & Jenkins-Smith, H. C. (2020). Sharpening Advocacy Coalitions. Policy Studies Journal, 48(4), 2020, 1054–1081. https://doi.org/10.1111/psj.12360

Weible, C. M., Sabatier, P. A. & MCqueen, K. (2009). Themes and variations: Taking stock of the advocacy coalition framework. Policy Studies Journal, 37(1), 121–140. https://doi.org/10.1111/j.1541-0072.2008.00299.x




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