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Outsourcing and "dismantling" of steady jobs at hospitals.

OBJECTIVE: To relate hospitals' organizational structure as the core of a web of outsourced services and flexible employment bonds among healthcare professionals in the context of finance capitalism, analyzing work arrangements based mainly on the type of employment bond.

METHOD: Qualitative research through ethnography, interviews, data analysis, and case studies. The case studies were concentrated in 3 hospitals located in the São Paulo metropolitan region under different management types: public administration; outsourced administration via a healthcare social organization (HSO); and private administration.

RESULTS: This study highlights a trend in outsourcing, dismantling of steady jobs, and shaping working relations asymmetrically in terms of healthcare professions.

CONCLUSION: These aspects are characteristic of contemporary capitalism and post-Fordist work organization. In this context, the state under sponsorship cripples the very existence of an effective human resources policy, creating a favorable environment for outsourcing and flexibility of employment bonds among healthcare workers.

OBJETIVO: Relacionar a estrutura organizativa dos hospitais como núcleo de uma rede de serviços subcontratados e a flexibilização dos vínculos contratuais dos profissionais de saúde no contexto de capitalismo financeirizado, analisando os regimes de trabalho condicionados centralmente pelo vínculo empregatício.

MÉTODO: Pesquisa qualitativa através de etnografia, realização de entrevistas, análise de dados e utilização de estudo de caso. Os estudos de caso concentram-se em três hospitais localizados Região Metropolitana de São Paulo com gestões distintas: administração pública; administração terceirizada para Organização Social de Saúde (OSS); e administração privada.

RESULTADOS: Destacamos a tendência da terceirização, do desmonte do emprego estável e a conformação de relações trabalhistas assimétricas para as profissões em saúde.

CONCLUSÃO: Esses aspectos são característicos do período do capitalismo contemporâneo e da organização pós-fordista do trabalho. Nesse contexto, o subfinanciamento do Estado inviabiliza uma política de recursos humanos efetiva, configurando o ambiente propício para as terceirizações e flexibilidade do vínculo empregatício para os trabalhadores de saúde.

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