The Brazilian Health System in the face of international typology: a prospective and inevitable discussion

Mauro Serapioni Charles Dalcanale Tesser About the authors

ABSTRACT

In light of comparative analysis of Health Systems (HS), this article aims to discuss the Brazilian HS in order to identify promising strategies for its development. Methodologically, based on studies about its formation/situation and on its main components of assistance and of funding, the approximation and distancing from the three main types of HS are discussed: 1- those based on universal national services (Beveridgeans); 2- those based on compulsory social insurance (Bismarckian); 3- those based on voluntary private insurance (Smithians). The Brazilian HS is mixed/segmented and includes both Beveridgean aspects, especially Primary Health Care (PHC) (municipalized and heterogeneous), and Smithians elements, such as private sector, specialized and hospital care. But it is little similar to the Bismarckian HS. In its Smithian and Bismarckian aspects, the law of reverse care is more evident, with public funding from the private sector to the wealthiest quartile of the population. For greater rationality, efficiency, equity, and universality, it is necessary to invest in the Beveridgean aspects of the Brazilian HS, which does not yet occur. This means reducing health tax expenditures, expanding and qualifying both PHC, through Family Health Strategy (FHS) and specialized and hospital care, as well as regionalizing its management, reducing inequalities and increasing the coordinating role of the FHS, by expanding or modifying the Family Health Support Center.

KEYWORDS
Health Systems; Unified Health System; Insurance health; Health policy, Brazil

Centro Brasileiro de Estudos de Saúde Av. Brasil, 4036, sala 802, 21040-361 Rio de Janeiro - RJ Brasil, Tel. 55 21-3882-9140, Fax.55 21-2260-3782 - Rio de Janeiro - RJ - Brazil
E-mail: revista@saudeemdebate.org.br