Austerity threatens universal health coverage in Brazil

Abstract

Michael Temer, Brazil's new interim president from the centre-right Brazilian Democratic Movement Party (PMDB), has unveiled an agenda of austerity measures to stimulate economic growth. In the manifesto Uma Ponte Para Futuro (October, 2015), he announced plans to reduce public spending, including the education and health-care sector. The minimum budget guaranteed by the constitution (3·8% of gross domestic product at present) would be abolished. The new Health Minister, Ricardo Barros, has revealed plans to end the monitoring of private health-care quality by the National Supplementary Health Agency (Agência Nacional de Saúde Suplementar), while encouraging Brazilian citizens to seek private health care instead of relying on the Brazilian National Unified Health System (Sistema Único de Saúde [SUS]).1Brasil Ministério da SaúdeGabinete do Ministro. Portaria No. 1.482 de 4 de Agosto de 2016. Diário Oficial da República Federativa do Brasil, Brasília.http://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?jornal=1&pagina=26&data=05%2F08%2F2016Date: Aug 4, 2016Google Scholar Personnel cuts among top executives of the National Department of Internal Auditing of the Unified Health System (Departamento Nacional de Auditoria do SUS [DENASUS]),2Brasil Ministério da SaúdeGabinete do Ministro. Portarias de 3 de Junho de 2016. Diário Oficial da República Federativa do Brasil, Brasília.http://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=06/06/2016&jornal=2&pagina=44&totalArquivos=72Date: June 6, 2016Google Scholar who were responsible for monitoring and evaluating SUS, also suggest the government's attempts to deregulate and diminish the role of public health care. Furthermore, Barros announced on July 21, 2016, a reduction of participation by foreign professionals in the country's More Physicians (Mais Médicos) programme,3Cancian N Programa Mais Médicos é provisório, diz Ricardo Barros, ministro da Saúde. Folha de S Paulo (São Paulo).http://www1.folha.uol.com.br/cotidiano/2016/07/1794201-programa-mais-medicos-e-provisorio-diz-ricardo-barros-ministro-da-saude.shtmlDate: July 22, 2016Google Scholar which was introduced in 2013 by Dilma Rousseff's Government in response to protests across the country by people demanding better access to physicians. Participation of foreign physicians in Brazil, mainly Cubans, has benefited the 63 million Brazilians living in remote and vulnerable areas, which previously had shortages of health professionals. In a country where about 80% of the population relies exclusively on SUS, such policies might cause widespread negative consequences. In the midst of severe economic crisis, with the unemployment rate at over 11% and gross domestic product having fallen by 5·4% from the preceding year, more people will be unable to pay for private health care and more will be dependent on the increasingly stressed public system. As a result, the great achievements of the past 10 years (increased coverage of universal health care, decreased infant mortality, and reduced mortality from chronic illnesses)4Macinko J Harris M Brazil's family health strategy—delivering community-based primary care in a universal health system.N Engl J Med. 2015; 372: 2177-2181Crossref PubMed Scopus (277) Google Scholar are likely to be reversed. Most members of congress supported the impeachment of the president, so the “neoliberal” policies of the interim government are likely to be approved. The intended resurrection of the economy through austerity will bring public health disasters in some or all of the aspects mentioned above. The effects of recessions depend mostly on the response of politicians to the early indicators.5Stuckler D Basu S The body economic: why austerity kills. Basic Books, New York2013Google Scholar However, the protests in June and July, 2016, in defence of universal health care have a capacity to influence the government's policies. We declare no competing interests. Brazil's health system woes worsen in economic crisisBudget cuts and political instability are exacerbating existing problems in Brazil's public health system amid increasing patient demand. Jonathan Watts reports from Rio de Janeiro. Full-Text PDF