Brazil’s Healthcare System
Elizabete Mendes, M.D., Ph.D, a
visiting physician in the pathology department at Johns Hopkins
University Hospital
in 2012, wrote several blog articles about Brazil’s healthcare system while
she was in the United States.
As a clinical pathologist in Sao Paulo,
Brazil, Dr.
Mendes is very familiar with her country’s healthcare system. In her blog, she explains how Brazil’s
healthcare system has improved, how the system is set up, and what is working
and not working in the system.
Constitutionally ordered in 1988, the creation of Brazil’s Unified
Health System (SUS) guarantees Brazil’s
citizens the right to healthcare. Mendes explains that there are five pillars
of Brazil’s
healthcare system: universal access, fairness, decentralization, social
participation, and participatory funding by cities, states, and federal
government. Brazil is the world’s fifth largest
country in size and has just fewer than 200 million people.
Brazil’s
health care system is made up of a complex network of providers and purchasers
of services. There are public services, private non-profits and for-profits,
and a supplementary health sector.
Although the public and private components are separate, they are very
much interconnected. Brazilians are allowed to use the services of each sector
if all are available at a health care facility they are using.
Health care access was not easy for
Brazilians until SUS established healthcare for all citizens of the country.
Since that happened in 1988, access has increased by 450%. Brazil’s infant mortality rate is now low
(6.31 per 1,000 live births) and the decrease has been attributed to better
access and education for pregnant women, and
the fact that decreasing infant mortality was treated as a public health
priority. There has also been a decrease in the birth rate from 3% to 1.2%
since Brazilian women have had greater access to contraception education and
contraceptive use thanks to the SUS. Another positive change in Brazil since
SUS was established is a decline in both the poverty index and the unemployment
rate.
Health services in Brazil
are organized into “tiers”: primary, secondary, and tertiary.
The primary care tier is
responsible for health promotion, disease prevention, access to comprehensive
services, and coordinating any care that requires more complex care such as a
hospitalization. The secondary-care tier is responsible for procedures that
involve medium complexity. These would
include advanced diagnostics and therapy, specialized advanced dental care, STD
counseling, HIV and AIDS counseling, occupational healthcare, rehabilitation
services, and emergency care. The tertiary-care tier is responsible for all the
high-cost and complex procedures provided by university-based public hospitals
and contracted private sector providers.
Although the establishment of SUS in Brazil has improved access and
overall health to many Brazilians, Dr. Mendes points out that there are still
problems in the system that are being worked out. Some of these challenges
include problems with efficiency, controlling costs, quality assurance, and
patient safety. One of the most surprising problems involves hospitals. Public
sector hospitals have only 35% of Brazil’s hospital beds. Since this
is not enough hospital beds to meet the demand, the government of Brazil pays the
private-sector hospitals for the care of government or public-insured patients.
Since 65% of the country’s hospital beds are in private-sector hospitals, the
government ends up funding private-sector hospitals out of necessity.
Seventy-seven percent of Brazilians are insured by private insurance
companies in plans that focus on young and healthy populations. There are different levels of coverage within
these plans so the insured can choose how much or little coverage they want.
There is a lot of freedom to choose how much insurance one wants beyond the
basic coverage. Within companies, executives usually buy more comprehensive
plans than entry-level employees. Another problem facing Brazil’s
healthcare system is directly related to how many Brazilians are insured by
private insurance companies. The private
sector is expanding in Brazil
due to its strong economic growth and stable financial status. Since the
government subsidizes part of the private healthcare sector, the public
healthcare sector is moving towards under funding. Brazil has recognized this
potential and in 2000 set up the National Supplementary Health Agency to
guarantee the legal and administrative regulation of the market of private
health insurance.
Dr. Mendes’ blog describes a country that has faced the inadequacies in
its healthcare system and intentionally averted any further decline. Brazil established the SUS in 1988
and mandated health care for all citizens. Since then and in spite of some
setbacks and problems with the healthcare system, Brazil has lowered infant
mortality, brought down the birth rate, and dramatically increased access to
healthcare for its citizens.
Emily Crigger
2/18/13
8:05PM
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