O ensino médico privado- expansão e tendências na Índia e no Brasil.

Abstract

Introduction: The private medical schools in India and Brazil are expanding rapidly. However, there is little evidence on how these countries have opened their education markets to the private sector and how the expansion of private medical schools is impacting health workforce planning and what are the trends in health systems in the context of implementing Universal Health Coverage. Objectives: To describe and analyse the growth of private medical schools in India and Brazil, highlighting the dynamics, trends and challenges of the educational market in these countries. Methods: A qualitative, empirical, cross-sectional, descriptive, exploratory study based on secondary data from India and Brazil, two countries of the BRICS Block. Private medical schools were the central element of analysis. The private medical schools were the central element of the study's analysis, which considers as private institutions those administered by private individuals or legal entities, with or without the intention of profit. Several methodological strategies were employed, including a review of the bibliography to identify the "state of the art" on the participation of the private sector in health and education, especially in the medical education. The Scoping Review method was also used to identify evidence, definitions and gaps in the literature. Finally, secondary data were collected from official websites in India and Brazil. The study covered the period from 2000 to 2018 and the whole search included documents in English, Portuguese and Spanish. Results: A theoretical model of analysis of the dynamics of the health labour market was developed, with a set of analysis variables that are presented and analysed according to the findings of the Scoping Review. In both countries, private medical schools currently represent more than half of all medical schools and enrolled students: 51% and 44%, respectively in India and 64% and 71%, respectively in Brazil. In general, they are concentrated in areas with better health indicators and higher income; there are concerns about quality and the regulatory system, considered bureaucratic and inefficient. Conclusions: The growing number of medical schools and enrolments does not appear to be linked to the strategies that address the growing demand for a sufficient health workforce, especially with regard to the shortage of physicians. India and Brazil seem to exemplify this problem. The growing trend in the number of medical schools and places does not seem to be linked to strategies to address the growing demand for a sufficient health workforce, especially with regard to the shortage of doctors. India and Brazil seem to exemplify this problem, because although health systems in many developing countries need more doctors and other health professionals, this increase would need to be linked to the health system development model. The study also shows that the increase in the number of private schools is not in line with the proposals for systems with universal health coverage and access, with the risk of contributing to increase existing inequities if efficient and transparent regulatory mechanisms are not developed.