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Brazil Healthcare

The public health system is complemented by a parallel medical sector made up of insurance and group health institutions, and a purely private sector. It is estimated that about 30% of the Brazilian population is covered by the two latter sectors for secondary care, with the SUS (Unified Health System) providing primary care for 95%, secondary care for 70%, and highly complex care for 90% of the population.

Brazil has 513,338 health professionals, of whom 40.1% are physicians, 26.8% are dentists, 13.2% are professional nurses, 10.1% are pharmacists, and 9.8% are veterinarians.

There are 757 inhabitants per physician; 1,132 per dentist; 2,330 per nurse; and 2,981 per pharmacist. Health facilities are distributed unevenly in the country and are most concentrated in the southeastern region.

In 1992, 9.3% of public and 12.9% of private facilities had their own equipment maintenance units, but 107 public units (0.22%) and 114 private units (0.5%) were deactivated for lack of equipment or funding to keep them going.

The public health system is financed from taxes and contributions to social funds collected by the government. The federal level, which must provide about 70% of the resources available for the sector, had as its main sources of income in 1997:

• the contributions to social funds;
• the Fiscal Stabilization Fund;
• National Treasury bonds;
• direct collection (fines, sales of inputs, etc.);
• regular taxes;
• others, 1.7%.

In Brazil there is no public health insurance of any kind, the SUS being wedded to the idea of health as a citizen's right. Thus, the public sector must cover 100% of the people resident in the country at all levels of care, though it is estimated that that percentage actually does not exceed 95% of the population in primary care, 70% in secondary, and 90% in tertiary care.

Despite reliable data on the service delivery in public facilities, there is no monitoring of either their actual coverage or the population without coverage. In 1995 this sector mobilised US$11.184 billion, 25.5% of the population having been covered by some kind of private health plan; coverage was rather uneven, with such people (78% of the total) concentrated in the southeastern region. The types of services provided under these plans has varied, owing to wide differences among the many modalities of health plans offered, though they concentrate essentially on secondary care.

According to the most recent data on current capacity of the health sector, in 1992 there were 49,676 health care establishments: 27,092 (55%) in the public sector and 22,584 (45%) in the private sector. There were 24,016 out-patient care facilities (65% public); 7,415 hospitals (28% public); 8,440 emergency care facilities (38% public); 16,400 specialised diagnostic centers (25% public); 1,078 blood banks (28% public); 7,050 specialised treatment centres-radiation therapy, chemotherapy, etc. (28% public); and 429 psychiatric care facilities (20% public). Eight percent of public establishments and 24% of private establishments provide in-patient care.

The country has 544,357 hospital beds, or 3.6 per 1,000 inhabitants, 25% in the public sector and 75% in the private sector. The Southeast and South regions of the country possessed about 60% of the total installed capacity in terms of establishments and available beds.

To summarise there is a comprehensive state health insurance for all employees as well as officially registered self-employed professionals. This gives access to free medical treatment in state facilities (public hospitals and points for out-patient treatment) however, these services are considered as low quality and usually do not fit the expectations of the middle class and above. Therefore, people seek for private coverage, giving access to treatment from private providers. While this implies double payment, people usually only tend to use their private coverage. Traditionally, most middle to big size employers offer health coverage to their employees under group contracts. Therefore, the group market in Brazil is very important (3/4 of premium income health from group 1/4 from individual).

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