The Brazilian Health Care System
– possibilities for collaboration
This report provides an overview of the historic basis of the Brazilian health care system as well as the current organization, including both private and public components. Furthermore, it describes and discusses current challenges and questions relating to the ageing demography and children. Finally, the report suggests some health care-related areas where an increased collaboration between Sweden and Brazil could be of interest for both countries.
- The Brazilian Unified Health System, Sistema Único de Saúde (SUS), established in the Brazilian Constitution of 1988, was an important expression of the Brazilian democratization movement in the 1980s and was, as such, spearheaded by health professionals and civil society movements.
- As a result, the SUS holds a series of particular traits: 1) it defines comprehensive, universal preventive and curative care as a constitutional right for 200 million Brazilians, thereby making the SUS one of the largest public health care systems in the world; 2) it stresses decentralized management and provision of health services along with community participation at all administrative levels; and 3) it operates through a particular mix of public and private participation, incentivized and supported even financially by the state itself, in which the private sector enters as a complementary and competing actor, fulfilling some of the tasks that the public sector may not be able to take on.
- The implementation of the SUS has since its inception been complicated by: 1) chronic underfunding; 2) inherent inefficiencies in the public-private service delivery model, essentially manifested in the inability to connect the two sectors; 3) similar shortcomings in the decentralized governance model, where communication and collaboration between different administrative units often are seriously hampered; and 4) a structural concentration of health services to more developed regions.
- Despite these limitations, the SUS has made considerable progress and achieved to: 1) significantly expand the capacity of the system; 2) vastly improve access to primary and emergency care; 3) reach universal coverage of vaccination and prenatal care; and 4) make considerable investments in human resources and technology, including the domestic production of strategic pharmaceutical products.
- Apart from the above, current managerial challenges and opportunities include: 1) access to competent personnel at all levels of the system; 2) the development of quality improvement measures along with systems for evaluation and continuous assessment; and 3) the many issues pertaining to increased investments in research, development and innovation.
- At the same time, medical challenges are changing at a fast pace, thereby raising new demands on health sector policies. Some of the more critical are: 1) the rapidly aging demography; 2) growing urbanization rates; 3) an increasing frequency of overweight and obesity; 4) a rapid increase in chronic and non-communicable diseases; and 5) violence and accidents following from extensive alcohol abuse.
- To conclude, we see from the Swedish perspective at least four areas of potential collaboration: 1) issues related to governance and decentralization in the health sector; 2) the development of quality improvement measures along with systems for evaluation and continuous assessment; 3) increased research and educational collaboration, mainly through the program “Science Without Borders”; and 4) several commercial opportunities, principally in the Brazilian health industry complex.