Analysis of information on mitigating SUS's judicialization in digital media.
| Autor | Siqueira, Fernanda Rodrigues de |
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Introduction
Marketing strategies are being increasingly adapted in the public sector. Among the discussions in the literature, we find the concept of public marketing (Pasquier & Villeneuve, 2018; Silva & Minciotti, 2021), which has become one of the essential activities for public brand building strategies (Zavattaro, Marland, & Eshuis, 2021).
Marketing of organizations and public services, within the scope of public marketing, is aimed at planning, implementing and controlling public policies oriented to meet social needs (Aleman, Gutierrez-Sanchez, & Liebana-Cabanillas, 2018; Silva, Bianchini, & Minciotti, 2021). For citizens to know about public services, it is essential that all coordinated actions are strengthened by broad institutional dissemination (Cezar, 2019). Therefore, communication can serve for both population's engagement and actions' transparency in the political, economic and social fields (Cezar, 2019; Ribeiro & Oliveira, 2013).
The way communication is conceived in digital media can increase the performance and the perception of brand value and the public service offered (Thomas, Fay, & Berry, 2020), allowing the management of image and reputation to facilitate achieving public sector's goals (Pasquier & Villeneuve, 2018; Zavattaro etal, 2021). Public marketing can even be associated with public brands, which represent consumers' (here citizens) perceptions and feelings about a particular product (or public solution), thus establishing a relationship among the citizen, the product offered and the organization (Kotler & Armstrong, 2015).
Every public policy effort is not only exclusively related to norms and their effectiveness (Ribeiro & Oliveira, 2013; Silva, 2015) but also, and perhaps mainly, to being recognized as legitimate by society (Meyer & Rowan, 1977; Rossoni, 2016). In this sense, marketing has the potential to create value, not only for products and services - from customer value capture, in the marketing sense (Kotler & Armstrong, 2015) - but it also has application in public policies designed to overcome obstacles faced by citizens (Silva etal, 2021; Silva & Minciotti, 2021).
In Brazil, public marketing gained fertile ground from the changes promoted by the State Reform Master Plan - PDRE, in the Portuguese acronym - based on the paradigm known as managerialist, which took place in the 1990s (Oliveira, Costa, Miranda, Mesquita, & Pereira, 2013; Silva & Minciotti, 2021), and assumed that the functions performed by the private for-profit administration could be easily transferred to public administration. This perspective received several criticism, giving rise to a set of new paradigms, known as the New Public Governance (Ronconi, 2011; Runya, Qigui, & Wei, 2015), in which marketing role is best used (Raksnys, Guogis, & Minkevicius, 2015).
In view of the emerging need to use public marketing in different public policies, we acknowledge the importance of the Brazilian health policy. Several sources indicate an exponential growth of judicialization (Lara, Fernandes, Penteado, & Serra, 2021), whose results do not benefit both citizens and public administration (Carvalho, 2007). Due to this phenomenon, alternatives were sought to minimize the large number of demands to the Unified Health Service (SUS), such as conflict mediation programs. In general, mediation is a space where the parties and other stakeholders get together to settle potential issues, in order to prevent the conflicts' judicialization, and, instead, to meet the citizen's demand (Conselho Nacional de Justica [National Council of Justice - CNJ], 2016). Some programs stand out in reducing judicialization, such as "SUS Mediado" (Mediated SUS) and Chamber for Health Disputes Settlement (CRLS), in the states of Rio Grande do Norte and Rio de Janeiro, respectively and the Permanent District Chamber for Health Mediation (Camedis), in the Federal District (Silva, 2018).
In this context, we consider that communication, especially through digital media, plays a fundamental role in disseminating information on conflict mediation programs, so that citizens have knowledge and access to them, rather than judicializing their demands of public health. That is why communication, as the most visible part of marketing, has been associated with the constant process of knowledge, persuasion and trust on what the public sector offers, which affects citizens' decision to make exchanges with the public service (Cezar, 2019).
Studies show the importance of marketing and communication when it comes to public health (Grier & Bryant, 2005; Gurrieri, Gordon, Barraket, Joyce, & Green, 2018; Hoek & Jones, 2011); however, these authors sought to understand the marketing phenomenon for promoting social behavior changes in order to reduce health problems. Although there is evidence on the application of marketing as a State strategy to foster public policies (Kaplan & Haenlein, 2009; Zavattaro et al, 2021), there is evidence of a gap in investigating the relationship between the legitimacy provided by public policies' communication and the real effectiveness that these programs seek to achieve. It is possible, for example, to have ineffective public policies with good marketing and communication structures that provide a misleading legitimacy, just as the opposite is also true.
Given this perspective, based on the practices involving "SUS Mediado", Camedis and CRLS, we raised the following question: how information on public policies to mitigate SUS's judicialization is disseminated in digital media to citizens and main stakeholders? Since information conveyed by digital media is a marketing strategy mechanism to establish a relationship with stakeholders (Pasquier & Villeneuve, 2018; Zavattaro et al, 2021), we understand that this is a relevant context, especially for public health, and this is the paper's contribution.
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Theoretical background
2.1 Public marketing
The concept of marketing has undergone significant changes over the years (Kotler & Levy, 1969; Silva & Minciotti, 2021). Currently, the American Marketing Association (AMA, 2017) defines it as "a set of institutions and processes for creating, communicating, delivering, and exchanging offers that have value for customers, consumers, partners, and society in general". Marketing applied to the public sector was driven by the universal view of the discipline for all organizations (Kotler & Levy, 1969), fitting into the objectives of public administration (Kaplan & Haenlein, 2009; Zavattaro et al, 2021).
Public marketing is the first step toward citizens' satisfaction (Aleman et al, 2018; Pasquier & Villeneuve, 2018), as it enables greater proximity between the State and citizens, if applied to meet the needs and expectations of society, either qualitatively or quantitatively (Cezar, 2019; Silva & Mnciotti, 2021). It allows the achievement of the efficiency-efficacy-effectiveness triad in public services' provision (Silva, 2015; Silva & Minciotti, 2021).
However, in contrast to other practices that were more easily consolidated in public administration, marketing's route through the areas of public administration proved more difficult than expected in the early 1980s (Bouzas-Lourenzo, 2010; Laing, 2003). Even in the political changes characterized by the New Public Management, there was a strong reluctance to adopt marketing concepts as means to understand and manage the uncertainty inherent to the new paths of public administration (Laing, 2003). In general, it has been associated with pure electoral advertising (Bouzas-Lorenzo, 2010).
The literature on public marketing became better used from the paradigm subsequent to managerialism, known as New Public Governance, which assumes a strong involvement of public management with its stakeholders (Runya et al, 2015; Raksnys et al, 2015), for higher administrative effectiveness of participatory democracy (Edelenbos, Klijn, & Steijn, 2010). This paradigm supports a new approach known as marketing in public services (Cezar, 2019; Silva et al, 2021), when public sector commitments seek to meet the needs and expectations of citizens through participation. In this case, the goal is to improve the efficiency of public service management, allowing a strategic, responsible and integrated public management, thus enhancing citizenship (Aleman et al, 2018; Silva, 2015).
In this process, communication is essential, seeking to remain closer and accessible to stakeholders (Cezar, 2019; Pasquier & Villeneuve, 2018; Ribeiro & Oliveira, 2013). Media evolution is one of the factors underlying organizations' trend to communicate more and more (Pasquier & Villeneuve, 2018; Thomas et al, 2020), which enables the development of marketing strategies through the dissemination of information and message projection. As a result, it encourages society to participate in political life and related matters (Cezar, 2018), as well as to achieve other goals, including, but not limited to, gaining trust and improving public image (Thomas et al, 2020; Zavattaro et al, 2021).
In recent years, when social media emerged as ubiquitous, governments have increasingly used different methods to convey their message (Thomas et al, 2020), allowing public communication to take on different levels (Pasquier & Villeneuve, 2018), among which stand out institutional communication and government communication. In general, communication has promoted public organizations, in order to facilitate access to their services or strengthen their legitimacy (Pasquier & Villeneuve, 2018; Rossoni, 2016). In democratic countries, communication usually has a governmental character, providing marketing campaigns and strategies about government decisions (Pasquier & Villeneuve, 2018), so that citizens can know them better and engage in spaces of public deliberation (Cezar, 2018,2019). In the latter case, the field of public marketing goes from a communication strategy to a strategic...
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