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HOW DOES THE HEALTH SYSTEM WORK IN BRAZIL?

In Brazil, health is a right for all and a duty of the State. (Article 196 of the Constitution of the Federative Republic of Brazil, 1988). What does this mean?

EVERYONE has the right to use the public health service in Brazil: rich, poor, Brazilians, foreigners, those with health insurance and those without. Access is UNIVERSAL.

It is the State's responsibility to ensure that all people have access to health services according to their needs, recognizing that not everyone is equal and that some groups may need more support to overcome inequalities. Even if I have health insurance, I have the right to access the services of the Brazilian Unified Health System (SUS). This means that a more needy person will have health policies created by the government in a more accessible way than I do. Does this mean that a more needy person will have priority in emergency care over me? NO! It only means that health policies created by the State will be designed to cover the needs of the most needy populations as a priority. This is called: EQUITY.

However, if I, who have private health insurance, want to use the public health service in Brazil (SUS) even if I don't need it, I can use and benefit from all the treatment tools offered by SUS. If the doctor prescribes medication, I can get it for free from SUS. If after an accident and recovery I need a physical therapist, I will have the right to a SUS professional. If I need an expensive exam like an MRI or need to see any medical specialty, even the most uncommon ones like a pulmonologist or otolaryngologist, I will have access. From the beginning of my treatment to the end, from emergency care to rehabilitation or specialized medical care, SUS will provide it. We call this: INTEGRALITY.

SUS works as follows: municipalities have their health departments, managed by the mayor and the city's health secretary. States have the state health department, managed by the governor and the state health secretary, and the health department managed by the President of the Republic and the health secretary of Brazil. The federal government is the highest authority of SUS, followed by states and cities. The federal government and the federal public health department create the rules, regulations, and resolutions for the operation of SUS, create federal public policies, and transfer funds to states and cities. We call this: HIERARCHY.

But in Brazil, who creates the public health policies of SUS and who manages the SUS funds are the cities! For example, in a developed city on the coast of Brazil, there is a large number of elderly people... the quality of life in this city is very good and people live longer, there are few young people compared to the elderly, and the mayor and the city's health secretary decide to invest in programs for elderly health as a priority public health policy. In a city in the metropolitan region of São Paulo, busy, with a population of 900,000 inhabitants, health problems are related to climate-related diseases (such as respiratory diseases) and a high birth rate. The mayor and the health secretary of this city invest in public policies aimed at these problems, such as specialty clinics and maternity monitoring centers. Understand, although the highest authority of SUS is the federal health department, it does not interfere in the policies created by these two cities, even though they are completely different. We call this: DECENTRALIZATION.

The funds to finance SUS come from tax collection, and a percentage of taxes must be allocated to SUS. Most of the funds go to states and cities. And who oversees? Of course, each level of government: federal, state, and municipal has its oversight bodies, but the main protagonist of this oversight is the councils. How the money will be invested in SUS is decided by the population! The Brazilian Unified Health System is democratic and has the participation of the population through health councils in cities, states, and the federal government. We call this: POPULAR PARTICIPATION.

So we have these pillars in SUS:

  • 01-UNIVERSALITY
  • 02-EQUITY
  • 03-INTEGRALITY
  • Fundamental Principles
  • 04-HIERARCHY
  • 05-DECENTRALIZATION
  • 06-POPULAR PARTICIPATION
  • Organizational Principles

Brazil has more than 218 million inhabitants and, according to federal government estimates, more than 70% of the Brazilian population uses SUS. SUS is the largest public health system in the world and nobody pays for it. It is the State's duty.

And what if someone doesn't want to use it? And what if someone prefers to pay for private health insurance? No problem! And the citizen will not pay for it! Remember the principle of universality and the constitution that says it is the State's duty to bear the health costs of the citizen? In Brazil, the citizen who prefers to pay for private health insurance is exempt through income tax from costs related to health. IT IS THE STATE'S DUTY!