Comparative Health Policy Library

BRAZIL | Summary

OVERVIEW

GDP: 1.84 Trillion USD1
Health Expenditure (% of GDP): 9.47%2
 
  • Population: 212.9 million
  • Housing: 87.4% Urban, 12.6% Rural

HISTORY

Brazil’s health system was established in 1923 with the creation of a social security system for the formerly employed in the private sector. During this time, health was not a constitutional right, therefore access was not a priority in the health system. The model of social security was based on compulsory contributions by employers and employees in the private sector. This model did not include agricultural and informal sector workers, leaving a majority of the population uninsured. The structure of health finance established in this era was practically untouched until the 1970s when health reform was initiated to extend health coverage for certain medical services. The Ministry of Health was also tasked with the provision of medical care for those not covered through the social security administration. However, health had still not been stated as a right for the population.6 

After the Brazilian Military Regime ended in 1985, Brazil prioritized more rights and freedoms to the citizens in the new constitution as well as a focus on social development.7 “Health is a right of all and an obligation of the State, guaranteed by socioeconomic policies which seek the reduction of the risk of diseases and of other grievances and to the universal and equal access to the actions and services in its promotion, protection and recuperation” is stated in the constitution.8 The current health system, conceived during this time of social movements and re-democratization, is known as the Sistema Único de Saúde (SUS). It was officially created in 1988 by the new Brazilian constitution. Since 1990, there has been incremental expansion of this health system in efforts to reach universal health coverage.4 In 1996, the federal government introduced an earmarked tax for healthcare on financial transactions which raised around 20 billion USD in 2007. Later this tax was taken off because there were concerns of excessive tax burdens. There were also concerns that the money raised from this tax was not being allocated completely to health care as originally intended.9 Overall, the SUS increased healthcare access to a significant proportion of the population in Brazil in a time where privatization of the health system was increasing.10

HEALTH & HEALTH SYSTEM

Brazil has a robust public health system that covers every person legally living in the country.12 The Sistema Único de Saúde (SUS) is Brazil’s national health system that reaches universal health coverage within the country. It is decentralized with administrative responsibilities at all levels of government: federal, state, and municipal. The delivery of care is handled at the state and municipal level. The constitution of Brazil defines the universal right to comprehensive care at all levels such as primary, secondary, and tertiary. There is also a pillar of social participation in SUS through creating and monitoring the implementation of health policies through federal, state, and municipal health councils. The SUS offers many services free of charge such as preventative services, primary care, outpatient care, inpatient care, maternity care, mental health services, pharmaceuticals, dental care, vision care, and physical therapy for residents and visitors, including undocumented individuals.3 The SUS requires a personal health card with medical records that allow coordination between services. They are officially named the National Health Identification cards and can be obtained at any hospital, clinic, or health center by presenting an identity card, proof of residence, and a tax payer’s number.12

The public and private health sectors in Brazil are completely independent of each other. Public hospitals in Brazil offer free, high-quality care at the point of delivery but do struggle with overcrowdedness and long wait times. The conditions in public hospitals are lower than private sectors, for example, lack of air conditioning or missing certain medical equipment. Although foreigners can receive free care at these facilities, most prefer to opt for private services which they have to pay for.13 Private health insurance is voluntary and supplementary to the SUS. Approximately 23% of Brazilians have private health plans which grants them access to care at private facilities. The majority of beneficiaries receive private health insurance through their employers as a benefit. Individuals and legal entities can deduct health costs from their taxable expenses.4 

The largest concentration of doctors and hospitals are located in the urban areas. This poses challenges for the rural and low-income areas of Brazil, in addition to other public health disparities. Poor sanitary and housing conditions negatively affect the health of Bralizians living in Favelas, mostly around São Paula, Rio de Janeiro and other large cities. To address these issues, government programs and privately supported clinics have been established in many favelas to improve health outcomes, especially in maternal and child care. In these areas, there have also been improvements in the systems of potable water and sewage that have reduced the spread of disease.14

HEALTH INDICATORS & DEMOGRAPHICS

  • Fertility Rate: 1.7 live births per woman  
  • Life Expectancy (Female, Male): 80, 73
  • Infant Mortality Rate: 11 deaths per 1,000 live births  
  • Child Mortality Rate: 13 per 1,000 live births
  • Maternal Mortality Rate: deaths per 100,000 live births  
  • Prevalence of Obesity: 22%
  • White: 47% 
  • Pardo (Mixed Race): 43% 
  • Black: 8% 
  • Asian: 1.5%
  • Amerindian: 0.5% 
  • 0-14 years: 21.9%  
  • 15-24 years: 16.3% 
  • 25-54 years: 43.7% 
  • 55-64 years: 9.4% 
  • 65 years and over: 8.6%

References

1. The World Bank. (2020). Brazil . Data. https://data.worldbank.org/country/brazil.

2. The World Bank. (2017). Current health expenditure (% of GDP). Data. https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS. 

3. Brazil Population 2020 (Live). Brazil Population 2020 (Demographics, Maps, Graphs). (2020). https://worldpopulationreview.com/countries/brazil-population. 

4. Tikkanen, R. (2020, June 05). Brazil. Retrieved from https://www.commonwealthfund.org/international-health-policy-center/coun...

5. Geography Now! Brazil. (2015). Retrieved from https://www.youtube.com/watch?v=JFfcD-SkqIc

6. Elias, P., & Cohn, A. (2003, January). Health reform in Brazil: Lessons to consider. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447689/

7. Napolitano, M. (2018). The Brazilian Military Regime, 1964–1985. Oxford Research Encyclopedia of Latin American History. https://doi.org/10.1093/acrefore/9780199366439.013.413

8. Brazilian Federal Constitution Article. (n.d.). Retrieved from http://conselho.saude.gov.br/web_sus20anos/20anossus/legislacao/constitu...

9. Brazil's march towards universal coverage. (2011, March 04). Retrieved from https://www.who.int/bulletin/volumes/88/9/10-020910/en/

10. Paim J;Travassos C;Almeida C;Bahia L;Macinko J;. (n.d.). The Brazilian health system: History, advances, and challenges. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21561655/

11. Brazil Age structure. (n.d.). Retrieved from https://www.indexmundi.com/brazil/age_structure.html

12. Health and health care in Brazil. (n.d.). Retrieved from https://www.aetnainternational.com/en/individuals/destination-guides/exp...

13. Healthcare in Brazil. (n.d.). Retrieved from https://www.internationalstudentinsurance.com/brazil-student-insurance/h...

14. Martins, L., & Schneider, R. (2020, September 21). Primary and secondary school. Retrieved from https://www.britannica.com/place/Brazil/Primary-and-secondary-school

15. Brazil Demographics. (n.d.). Retrieved from https://www.worldometers.info/demographics/brazil-demographics/

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