The recent document on Public Foundations issued by the Ministry of Planning (2005) and the crisis in the hospital area bring the issue of public management models back to the agenda of Brazil's National Health System (SUS). This paper brings up changes in civil service management models within the context of the State restructuring processes of the 1990s in Brazil, particularly in the National Health System (SUS). The approach examines, initially, the legal status of healthcare entities at the State level, establishing their publics by their objectives; second, it discusses the context of State reforms and the changes proposed. The authors feel that the criteria and parameters used for institutional assessments must encompass four aspects: subordination to healthcare policy; status under the law; managerial efficiency and control capacity. Based on an overview of the various options, a more detailed comparative analysis is carried out of the proposal for public foundations established under private law. The comparative analysis of public foundations proposed for hospital management also examines other entities sharing common characteristics, such as Social Organizations. Moreover, the State Foundation and Management Contract may be viewed models paving the way to the modernization of the State, reintroducing the issue of hospital reform to Government agenda.
State reform; Public foundations; Hospital management reform