einstein (São Paulo). 21/Nov/2018;16(4):eED4811.

What is the future of the Brazilian Public Health System?

Jacyr Pasternak ORCID logo

DOI: 10.31744/einstein_journal/2018ED4811

We are the country with the largest population on the planet that has a comprehensive healthcare service, with no “out-of-pocket” payment by end users.() It was clearly inspired by the British model of the National Health Service. The Brazilian system has some aspects that work very well: our vaccination program is excellent and provides more types of vaccines than richer countries.() Our healthcare system for HIV-infected individuals is outstanding. Nevertheless, the Brazilian Unified Health System (SUS – suffers from a chronic shortage of financing() and lack of coordination among the various authorities of the Republic responsible for its management. The system is extremely fragmented, and management is often given to people appointed for political commitments, and not by their merit. Coordination among the various levels of managers is faulty, and investment in the system has dropped constantly. Brazil does not invest poorly in health (approximately 9% of its Gross Domestic Product) – in that, 47% of expenses are paid with public funds and the remaining (53%) comes from the private sector. Countries with structures similar to that of SUS, such as the United Kingdom (which invests 83.2% in the public health system), Canada (71.1%), Italy (77.6%), and Holland (84.8), show how small is our portion of expenditure on public health, compared to what is spent in the United States, which invests 48.5% of funds available in public healthcare systems, such as Medicare.()

One particular aspect of SUS is the preferential use of its resources by people who are far from the Brazilian economic base. Costly medications or drugs unavailable in the country are regularly provided to people with knowledge and expertise, who know how to request them by going through the Judiciary power, whereas more socially deprived people simply get lost in the attics of the system. As stated by one of our professors who also served as the Minister of Health, Dr. Adib Jatene, “the problem of the poor is not only being poor, but also not knowing anyone with influence.” Similarly, people who are better educated and who have richer networking know where the resources are more readily available, and where the best trained physicians are located.

What is the future of the Brazilian Public Health System?