The papel' addresses the proliferation 01' different types of managernent and/ 01' 01' health professionals insertion as alternatives to the direct state administration in Brazilian public hospitaIs in the 90s. The basic assumption is that these types 01' management represent new forms 01' public-private articulation in the field 01' health care, which brings about a broader discussion about the State pattern 01' intervention in health care. Thus, the process 01' proliferation of the alternative types 01' management is analyzed on the basis 01' three main dimensions, which are somewhat connected: a) the macro political context in which this proce i found. panicularly the national debate about the State Reform and the carrying out 01' health care policies; b) the strategies 01' the political actors - the managers 01' the health care system - for the implementation 01' these types 01' management in public hospitaIs; c) the influence of the specific characteristics 01' the institutions - at the federal, state and municipal levels - in the adoption of these proposals. The field research was restricted to the public hospitaIs located in the Municipality of Rio de Janeiro. The types 01' management identified in the study were: the Social Organization model; the private foundatiolls that support hospitais; the cOlltracting Oltl of l11allagelllellt in hospitaIs; and the cOlltractillg oue of assistclIlce activities in hospitais, mainly through hiring the services of cooperati ves of health care professionals. It has been noted that the proliferation of the alternative types of management in these hospitais increases in the post-95 period, in accordance to the national guidelines of the State Reform and to the multiplication of these experiences throughout the country. However, this process presents different characteristics in hospitais at the federal, state and municipal levels. The research also points out the relevance of the choices and 01' the political strategies of the health care system managers for the adoption of these proposals.
State and health care; State Reform; public-private relations in health care; management 01' public hospitais