Abstract
Significant changes have been witnessed in the Brazilian health system over the last 30 years. This article outlines trends in outpatient and hospital care, staffing, and health service use during this period. There was a significant expansion of the public health network, particularly of primary care services, leading to improved access to consultations and a reduction in hospital admissions. However, there is a persistent shortage of health professionals in Brazil's public health system, particularly dentists. Despite improvements in coverage, the public system continues to face serious challenges, particularly with respect to funding, service provision, and its relationship with the private sector.
Highlights
Under the National Social Welfare Institute (Instituto Nacional de Previdência Social - INPS), the design of Brazil’s health system was based around a concentration of resources in the social welfare system, a centralized model of funding and administration, standardization of benefits, and the expansion of the social coverage of medical services to insured workers, favoring outsourcing of services to the private sector[1]
Specialized individual medical care was provided by the Ministry of Welfare and Social Assistance (Ministério da Previdência e Assistência Social), while the Ministry of Health’s role was limited primarily to regulation and preventive actions
The movimento sanitário that emerged in Brazil in the 1970s defended health reform based on a shift from a primarily biological approach to dealing with health problems towards an historical-structural approach that took into account the socioeconomic and political determinants of health[1,2]. Those who championed this approach argued that the state should play a key role in health promotion, health system regulation and service provision and that the democratization of access to health services and care system restructuring were an imperative[3]
Summary
The movimento sanitário (health movement) that emerged in Brazil in the 1970s defended health reform based on a shift from a primarily biological approach to dealing with health problems towards an historical-structural approach that took into account the socioeconomic and political determinants of health[1,2] Those who championed this approach argued that the state should play a key role in health promotion, health system regulation and service provision and that the democratization of access to health services and care system restructuring were an imperative[3]. While the Constitution provides that the provision of public health actions and services under the SUS should integrated, regionalized and hierarchical, it states that health care is open to private enterprise It provides that when SUS resources are not sufficient to guarantee full coverage in a particular area, the SUS may resort to outsourcing services to the private sector[7]. Based on an analysis of trends in the supply of health establishments and resources and the use of health services in Brazil over the last three decades, this article explores the effects of health actions and policies and the role played by the private sector providers in the provision of NHS services
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