The institutional design of the SUS: is its hybrid public-private nature leading to better health system?

Abstract

Private management has become an important alternative for the provision of public services in Brazil - a result of a widespread belief that associates the non-governmental sector with higher levels of efficiency. The aim of this paper was precisely to measure the impact of private management in SUS, through the estimation of a regression model for counting data. The database used consisted of a panel of data, organized on the basis of information from the Brazilian Institute of Geography and Statistics and the Information Systems Department of the Ministry of Health, Datasus, covering all Brazilian municipalities between 2000 and 2003. Results did not confirm that private management of public funding leads to a reduction in the number of deaths. In fact, results are unexpectedly significant and negative, which suggests that the improvement in the Brazilian public health sector, i.e. the reduction in child mortality rates, was not caused by its hybrid public-private institutional design.