Is Universal Health Care in Brazil Really Universal?

Abstract

Since Brazil's adoption of a universal health care policy in 1988, the country's health care has been delivered by a mix of private providers and free public providers. We examine whether income-based disparities in medical care usage still exist after the development of the public network using a nationally representative sample of over 46,000 Brazilians from 2003. We find robust evidence of a positive association between income and doctor visits, private doctor visits, and private medical expenditures. Interestingly, we also find evidence of a positive relationship between income and public doctor visits that disappears after including local area fixed effects to account for variation in availability and quality of medical services across localities. Additionally, we estimate income elasticities of private doctor visits and medical expenditures of well below one, suggesting that private care remains a necessity despite the availability of free public care. These results together suggest that the public health care system in Brazil is not effectively reaching everyone.