Abstract
The objective of this article is to analyze the development of the public and private offer for the universalization of health services, specifically, for the progression of the public network. The time period examined is from 2008 to 2015, when there was considerable economic growth and expansion of private health insurance and an unprecedented historical period with economic growth and reduction of social inequality. Across 5570 municipalities, the multivariate analysis model was used to estimate the level of concentration and the imbalance (heterogeneity) of installed health capacity of the network of health care services. Public spending on investment and human resources showed positive variation in all regions and in almost all population strata. The offer by the Unified Health System (public) of primary health care increased by 8000 new establishments in all regions, especially in previously uncovered cities and cities that had shortages of public health services. Public universalization almost reached its maximum, with about 70% of municipalities. The only setback was the significant reduction of 50% in the number of private establishments in primary health care services. The data suggest a positive movement toward the universalization of health services in Brazil, with the concentration of high-complexity care and the heterogeneity of the installed capacity being points for improvement.
Highlights
In Brazil, the Constitution establishes in its Article 196 that “Health is a right of all and a duty of the State and shall be guaranteed by means of social and economic policies aimed at reducing the risk of illness and other hazards and at the universal and equal access to actions and services for its promotion, protection and recovery” [1]
The term “in” represents municipal expenditure made from all sources of available health resources—federal, state, and own resources managed by the city [15]
Even with the clearly planned and rational objective of achieving economies of scale, the results indicate that a strong and persistent concentration of the network is still to be found in a small group of cities
Summary
In Brazil, the Constitution establishes in its Article 196 that “Health is a right of all and a duty of the State and shall be guaranteed by means of social and economic policies aimed at reducing the risk of illness and other hazards and at the universal and equal access to actions and services for its promotion, protection and recovery” [1]. Constitution of Brazil was promulgated on 5 October 1988, and it is relatively new in comparison with other countries, with its few years of existence, as is the regionalization of health in Brazil. The expansion had to be guided by the decentralization of primary services not yet available in several regions of the country and, at the same time, centralize highly technological services without penalizing the most distant cities. This would ensure both the scale necessary for cost reduction and simultaneously increase full coverage of low-, medium-, and high-complexity care
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