Modelos tecnoassistenciais em disputa na atenção primária à saúde no governo Lula 3: crítica a partir da categoria de neoliberalismo

Abstract

This dissertation analyzes the federal Primary Health Care (PHC) policies of Lula’s third administration, from 2023 to 2025, as a field of dispute between techno-healthcare models within the neoliberal totality that permeates health policy in contemporary Brazil. Neoliberalism is understood as a historical determination of capitalism in crisis, expressed simultaneously as a class project and as a governmental rationality. The study adopts a qualitative, exploratory approach, in the form of a critical essay, grounded theoretically and methodologically in historical-dialectical materialism. The category of techno-healthcare model is mobilized to understand disputes concerning the organization of care, financing, labor management, institutional configurations, and the relations between the State, the market, and society in PHC. The empirical corpus was composed predominantly of documentary sources, including programmatic documents, normative acts, ordinances, technical notes, public calls, management reports, administrative databases, historical series, official dashboards, and institutional materials from the Ministry of Health. The analysis focused on Lula’s third administration, mobilizing historical antecedents when necessary to understand the continuities, shifts, and contradictions of the recent period. The findings indicate that the federal administration repositioned PHC as a politically relevant field, with the renewed centrality of the Family Health Strategy, the expansion of the Mais Médicos Program, the reestablishment of multiprofessional teams, changes in federal co-financing, the strengthening of infrastructure agendas, and reconfigurations in oral health. However, this recomposition took place in a contradictory manner, preserving or reconfiguring elements associated with the neoliberalization of health policy, such as performance-based mechanisms, precarious labor relations, hybrid institutional arrangements, managerial inducements, and new forms of articulation between PHC and specialized care. The dissertation concludes that the policies analyzed express a contradictory recomposition of the PHC techno-care model, marked by partial advances, structural limits, and ongoing disputes over the public, universal, territorially grounded, and democratic meaning of the Brazilian Unified Health System.