More Doctors: Thoughts about a Controversial Health Care Policy

Abstract

The recent economic downfall has affected health care systems worldwide, sparking renewed discussions about the need for major reforms in many countries. In the wake of social protests, the Brazilian government swiftly proposed reforms addressing the poor distribution and shortage of medical personnel in underserved communities. The topic has gained substantial laymedia attention, but most debates have been driven by political motivations, rather than consensus of public health experts. We use the case of Brazil to illustrate potential problems of hasty efforts to solve systemic issues without addressing the underlying causes that have led to insufficient training, scarce infrastructure, and lack of public engagement on decision making. Brazil, a country of 198,000,000 people, has a decentralized universal health care system in which states and municipalities manage health care services [1,2]. The “Unified Health System” is considered by many an exemplary model [3]. The country has a broad free vaccination program, and nearly all children receive the full schedule [3,4]. It hosts an internationally renowned program that provides universal access to HIV prevention and treatment services [3,5]. And recent substantial investments have been effective in decreasing cases of tuberculosis [6]. Maintenance of this large enterprise, however, is costly, and federal health care spending is minimal [3]. Despite an increase in the per capita expenditure on health from US $107 to US $466, it is still below the world average of US $599 [4]. In Latin America, Brazil is behind Argentina (US $489), Costa Rica (US $553), and Uruguay (US $619) [4]. Compared with developed countries, the gap is abysmal; for instance, The Netherlands spends US $4820 per person [4]. According to the World Health Organization, health care spending in Brazil represents approximately 9.0% of its gross domestic product [4], yet half of the expenditures predominantly benefit 20% of the population with access to private health plans [7]. One of the indexes the World Health Organization uses to determine whether the health workforce is sufficient to address a