| 1 |
In the triple northern border (Peru, Colombia and Brazil) there is a demand for resources by the population of both countries. The search for access to the Brazilian health system is high, considering that bordering countries have private health systems. The constant complaint is the overload of the system in these regions, by both Brazilians and foreigners. Another situation is related to facilitated access to Brazil, through dry borders or access by bridges, which facilitate the arrival of citizens from other countries in search of SUS care. However, a lot of foreigners are still giving birth on the Brazilian side, to guarantee later care, a measure that municipal managers do not support. |
Bilateral agreements between Brazil and its neighboring countries have proven to be increasingly efficient in solving border region problems. However, these agreements are local and do not cover all borders, such as the agreements made in the Southern Arc composed of the states of Paraná, Santa Catarina and Rio Grande do Sul. |
Brazil, Peru and Colombia. |
| 2 |
There is free access to goods and labor through MERCOSUR, but there is a restriction on access to Brazilian health services for foreigners. However, cross-border citizenship is still being questioned, but urgency and emergency care is still being provided for this population, causing the overload of SUS related to labor and financial deficits in Brazil's public expenditures. |
To reduce the overload of the system, the best solution would be the integration of countries, since border municipalities are sometimes distant from large health centers. Even Brazilians need to displace to these places; however, foreign municipalities often have centers of specialties and with greater accessibility than in Brazilian capitals. |
Brazil, Uruguay, Argentina and Paraguay. |
| 3 |
There are no effective physical barriers on these borders, and when coupled with the precariousness of social services in countries bordering Brazil, there's migration of this population to the country, overloading social and health programs in Brazil. It is emphasized that these patients are faced with bureaucracies that often prevent them from receiving care; however, an increase in Brazilian expenditures occurs due to a floating population. |
Displacements, initiatives, discussions, specific agreements of this territory must be recognized, at the local, regional and MERCOSUR level. |
Brazil and Uruguay. |
| 4 |
The search for specialized care in other countries causes discomfort to patients, due to the distance of displacement, worsening of health status, treatments in unknown places, away from family and friends. In addition, these patients tend to stay a long period outside their homes and their country causing large financial deficits for these families, for example, parents may lose their family income by having to accompany their children in long treatments, just as is the case of cancer patients. |
At the Malta-UK border, bilateral agreements are already in place since the 1990s. The country serves up to 180 Maltese patients for free per year. If this number is exceeded, treatment payment is collected from Malta. What is seen, however, is Maltese crossing the border only when necessary, because they use their country's services whenever they can, such as periodic exams, and even care in specialized clinics. This way, care in the United Kingdom is only performed when there are no other alternatives. |
Malta and the United Kingdom. |
| 5 |
There is a search for cross-border service as to the benefits that Brazil offers to its citizens. Federal government makes the financial transfer only to the population from municipalities, which generates major problems in the public expenditures of the Brazilian twin cities Artigas (Uruguay) and Quaraí (Brazil); Rivera (Uruguay) and Santana do Livramento (Brazil); Aceguá (Uruguay) and Aceguá (Brazil); Rio Branco (Uruguay) and Jaguarão (Brazil); Chuy (Uruguay) and Chuí (Brazil) and Bella Unión (Uruguay) and Barra do Quaraí (Brazil). |
There have been attempts to establish social cooperation with the Uruguayan border, however, Uruguay has a public policy centralized only in the federal government. Consequently, municipal managers do not have autonomy for decision making, hindering the trans-border relations. |
Brazil and Uruguay |
| 6 |
Currently, there is no Brazilian health program to serve the population living in border regions. In 2005, the Unified Border Health System (SIS-Fronteira) was created to verify the demand in the region, to improve health care service in these places. For twin cities, the main benefit of this program was to send additional funds to this region to meet the expenses of foreign patients. |
SIS-Fronteira was a program of the Ministry of Health, aimed to improve care in border regions, ended in 2014. It was considered the best way to improve care in these regions; without the program, there are no other initiatives by the Ministry of Health for these places. |
Brazil. |
| 7 |
It highlights the migration of cross-border citizens to the Brazilian twin cities to go after care and enjoy the available initiatives of Brazilian social policies. Once again, the role of MERCOSUR is discussed as only of financial interest, because when citizens of another nationality have a health problem in Brazil the first service is performed in this country and later sent to their home country, which does not have a public health system. |
The need for binational agreements to extend Brazilian rights to crossborder patients who do not have documentation is emphasized, which makes it impossible to provide adequate care. |
Brazil, Uruguay and Argentina. |
