Universalization and Privatization: How Policy Analysis can Help Understand the Development of Brazil’s Health System

Abstract

The article addresses the present configuration of Brazil’s health system. Although it is defined as comprising universal access, hegemonic public funding and direct provision of care, today it is fragmented and under private sector hegemony, with strong inequity in health care provision. Comparison between health expenditure indicators in 26 emerging countries shows that state expenditures have been of lesser magnitude, even as compared with other emerging countries. Out-of-pocket expenditures are high and that compromises equity. The failures of Brazil´s health reform are seen as an outcome of the pattern of organization of domestic collective interests. It is argued that, as the Constitution proposed no veto against the market operating in the health sector, interests with greater voice have succeeded in imposing their preferences in decision-making arenas for private health care. The discussion is based on policy analysis literature and health system typologies. The data are analysed by descriptive statistics.

Keywords:

• policy analysis
• Brazil’s health policy analysis
• comparative analysis of health spending
• emerging countries
• Brazil’s health system

Additional information

Notes on contributors

Nilson Do Rosário Costa

Nilson do Rosário Costa is senior researcher at the Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Brazil. He has a background in social sciences, urban planning and economics. His main research interests are public policy, innovation and development of social protection and of national health systems and he has published many books and articles in those fields.

Jeni Vaitsman

Jeni Vaitsman is sociologist, senior researcher and lecturer in the Social Sciences Department of the Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Brazil. She has conducted evaluation studies and research projects in the fields of gender, family, values, health and social protection policies and has published books and articles in those fields.