We analyze Brazilian health system in comparative perspective. Middle income beneficiaries migration to pre-paid private insurance makes Brazilian case similar to United States. Public hospital services delivery shows an important retrenchment enhanced by demographic growth and new expectations due to constitutional definitions. Retrenchment is selective and concentrates on obstetric and clinic services and private for-profit services. To ensure equal access it is necessary to improve public spending; diminish out-of-pocket spending; develop organizational reforms; improve government capacity.
Unified Health System; Hospital services delivery
