The contracting policy of teaching hospitals: what did actually change?

The Teaching Hospital Restructuring Program was introduced as a strategy to fight the crisis in this sector. It brings to new funding, management and relationship standards between teaching hospitals and health system. This study presents the results obtained from a multiple case study involving four teaching hospitals whose con-tracts were executed in 2004. In 2010, a number of 32 interviews were conducted with both hospi-tal and SUS managers, in addition to managers connected with the Federal Government Depart-ments involved in the contracting system. By using elements from the micropolicy of health organiza-tions as theoretical reference, the database was re-visited with the goal of analyzing possible changes derived from such governmental policy applied in the daily life of teaching hospitals, in an attempt to explain the position taken by the diverse insti-tutional actors as well as the main role played by the managers and the difficulties encountered in its introduction. Despite the improvements in the financial situation, the changes observed in tea-ching hospitals were not significant. An analysis of the contracting policy leads to an understanding of how a consistent and idealized project can re-produce the usual conservative behavior found in public management.