Today, I will review Brazil’s health care system.
According to the Economist:
“Created in 1989 from the merger of two state systems, one for those in formal work and the other for everyone else, it is exceptional in Latin America, which by and large continues with the two-tier public system Brazil abandoned. The 1988 constitution declared health care to be the right of the citizen and its provision the duty of the state. ICESP enshrines that promise: according to Paulo Hoff, its clinical director, its patients, both poor and better-off, get care which compares well to that of his private patients at the nearby Sírio-Libanês Hospital.”
Brazil’s Programa Saúde da Família (PSF), launched in 1994, is one step towards interdisciplinary basic health care for most Brazilians. The PSF implements a national policy for primary care settings with the aim of substituting part of the traditional model of primary care based on medical specialists. As its name says, its main focus is on families instead of individuals, and it is organized around multidisciplinary Family Health Teams, formed by a core of professionals such as physicians, nurses, dentists, psychologists and social workers, as well as community health agents, a kind of “barefoot doctor”. Brazil has currently (August 2009) approximately 30,000 of these teams, deployed in 5,241 of its 5,656 municipalities. By 2005 over 80% of municipalities had been reached. However, since these consisted mostly of small rural municipalities, this covered 35% of the population.
But there is a gap between the aspirations of SUS and the reality. Funding is an inadequate hotch-potch, part-state, part-federal, and varies wildly from place to place. More than two-thirds of ICESP’s (Instituto do Câncer) budget of 350m reais ($225m) comes from São Paulo’s state government. Few other states are rich enough to provide such generous top-ups. SUS’s family doctors reach only one Brazilian in two. Another quarter have private-health insurance; the remainder, mostly poor people, live in remote rural areas or violent urban slums where the service is lacking. They must either pay out of pocket or take their chances in crowded hospital emergency rooms.”
Further, basic indicators are not as good as peer countries. Life expectancy is lower than in Mexico, Argentina, Venezuela and Chile, and the infant mortality rate is the highest among these countries.
“A recent survey of Brazilian health care published in the Lancet, an international journal, argued that SUS gets poor value for the money it spends on drugs, because too much goes on complying with court orders granted to patients who use the constitution’s lofty promises to demand expensive treatments not automatically covered by the system. And too much of the budget still goes to hospitals rather than the Family Health Programme, says Michele Gragnolati of the World Bank.”
- Brazil GDP per person: $10,800
- SUS (Public) spending as a share of GDP: 3.1%
- Health care spending as a share of GDP: 8%
- Share of health care spending that is privately funded: 60%
- Life expectancy at birth: 72.5 years
- Infant Mortality Rate: 21.17 deaths per 1000 live births
- Number of beds per 1,000 (global average): 2.4 (4.3)
- Nurses per 1,000 (global average): 29.1 (60.3)
- Physicians per 10,000 (global average): 16.9 (23.4)
- Brazil’s Population: 203.4 million