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Runninghead: BRAZILIAN HEALTH SYSTEM
1

The Brazilian Health System

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Abstract

The public health system (SUS) is one of the largest public health systems in the world.

 

It ensures universal, comprehensive health care and it is free to the entire population of the country.  The public health system was created in 1988 by the Brazilian federal constitution to be the health care for all Brazilians.  Besides offering consultations, tests, and hospitalizations, the system also promotes vaccination campaigns, prevention, and sanitary surveillance.

The SUS was created to provide equal service and care, and promote the health of the entire population.  The system is a unique social project that materializes through health promotion, prevention, and Brazilians’ health care.

For nearly 22 years of existence, the National Health System (SUS) has established itself as a major public policy in Brazil promoting social inclusion and seeking to continuously strengthen their basic pillars of full health care, and universal and equal access. It is the only access to health services for 160 million Brazilians (80% of the population), SUS is developing mechanisms to improve management and expand its scope. In 2009, it performed 3 billion outpatient visits, 380 million medical visits, 280,000 heart surgeries, and 10 million procedures in radiotherapy and chemotherapy. In addition, SUS is one of the largest public organ transplant programs in the world, won international recognition for the success of mass vaccination campaigns, and is the only developing country to guarantee free comprehensive treatment for people with HIV (Brasil, 2011).

The Unified Health System (SUS) was created from the Federal Constitution of 1988 stating that the entire population has access to the public health. Previously, National Institute of Medical Welfare (INAMPS) was in charge of healthcare. It was restricted to the employees who contributed to social security; others were attended to only through philanthropic services (Brasil, 2011).

Health posts, hospitals (including university laboratories), blood banks, services of Sanitary Surveillance, Epidemiological Surveillance, environmental monitoring, foundations, and research institutes such as FIOCRUZ – Fundacao Oswaldo Cruz and the Instituto Vital Brazil, are part of the Sistema Unico de Saude (Brasil, 2011).

History

The context of the Brazilian health system is constituted by a variety of public and private organizations established in different historical periods. In the beginning of the 20th century, campaign molds were realized and implanted nearly by the military activity public health. Authoritarian nature from those campaigns generated opposition from the population, politics, and military leaders. The opposition induce to Vaccine Rebellion in 1904, the resistance episode of a campaign compulsory vaccination against smallpox sanctioned by Oswaldo Cruz, the then Director General of Public Health (COSTA, CHAGAS, & SILVESTRE).

The Brazilian model of state intervention of the 1920’s and 1930’s happened when the civil and social rights were united to the individual position in the labor market (COSTA, CHAGAS & SILVESTRE).

The Brazilian social protection system has expanded during the administration of President Getulio Vargas and military governments. The process of decision-making and management system were carried out without the participation of society and were centered in large bureaucracies (COSTA, CHAGAS & SILVESTRE).

The social protection system was fragmented and unequal. The health system was created by an underfunded Ministerio da Saude and by the medical welfare system. Provisional service was provided by institutions for retirement and pension divided by occupational category each with different services and level coverage. People with sporadic jobs had an inadequate supply of services; composed of public services being philanthropic or health private services paid out of pocket (COSTA, CHAGAS & SILVESTRE, Ministerio da Saude, 1997).

After the military coup of 1964, government reforms prompted the expansion of a predominantly private health system; especially, in large urban centers (COSTA, CHAGAS & SILVESTRE).

Following a quick coverage expansion, this included the extension of social security for rural workers (COSTA, CHAGAS & SILVESTRE).

Between 1970 -1974, there were budget resources available to repair and build private hospitals. The responsibility for the health care provision was extended to trade unions and philanthropic institutions; this offered health care to rural workers (COSTA, CHAGAS & SILVESTRE).

Direct subsidies to private companies, for the provision of medical care to their employees, were replaced by income tax rebates; which led to the expansion of health care and the proliferation of private health plans. The increased coverage of social security and health market based payments to providers in the private industry based on services performed (fee for service), generated a crisis in social pension funding; which, together with the economic recession of the decade 1980, was fueled by the desires reform. The Brazilian proposal began to take shape in the mid-1970s; it formed during the fight for democratization. The sanitary movement reform grew and formed a parliamentary alliance with progressive managers of municipal health and other social movements (COSTA, CHAGAS & SILVESTRE).

At the beginning of the Brazilian government, there was no organization for healthcare and was solely concerned with purely an export economy. The government was without any clarification with society under public concept that would be adapted to the quality improvement of life. The disease situations in the country were treated according to the appearances in mass, and when they hindered exports and the country’s image internationally. In other words, what is required of the health system was a sanitation policy and eradication of goods and/or control of diseases that could affect the Brazilian economy (COSTA, CHAGAS & SILVESTRE).

In 1974, INAMPS was created by the military regime and was intended to provide medical care to those who contributed to social security or to hired workers. The INAMPS had their own establishments but most of the service was performed by the private sector; the covenants established by the compensation procedure (COSTA, CHAGAS & SILVESTRE).

The Sanitary Reform movement was born in the beginning of the academic decade of the 1970’s as a form of technical and political opposition to the military regime. It was embraced by other sectors of society and the opposition party of that period – the Movimento Democratico Brasileiro (MDB). In the mid 1970’s, there was a crisis in the financing of social security with repercussions on INAMPS. In 1979, the General Joao Baptista Figueiredo took office with the promise of political openness. The Health Committee of the Chamber of Deputies promoted in the period of 10/9-10/11 1979 the Symposium on National Health Policy; which had the participation of many members of the movement and reached the same conclusions highly favorable. Throughout the 1980s, INAMPS went through successive changes with progressive universalization of the service as a transition to SUS (COSTA, CHAGAS & SILVESTRE).

The 8th National Health Conference was a milestone in the history of SUS for several reasons. It was opened on March 17, 1986 by Jose Sarney, the first civilian president after the dictatorship, and CNS was the first to be open to society and was important in spreading the health reform movement. The 8th CNS resulted in the implementation of the Unified and Decentralized Health System (SUDS), a partnership between INAMPS and state governments, but most important formed the basis for the “The Health” of the Brazilian Constitution of October 5, 1988. The 1988 Constitution was a milestone in the history of Brazilian public healthcare by defining healthcare as “a universal right and duty of the state.” The implementation of the SUS was done gradually: first came the suds, then the incorporation of INAMPS the Ministry of Health (Decree No. 99060 of March 7, 1990), and finally the Organic Health Law (Law No. 8080 of September 19, 1990) founded the NHS. In a few months, the Law No. 8142 of December 28, 1990 was released, which showed the SUS one of its main characteristics: social control, i.e. the participation of population in the management of the service. The INAMPS was only abolished in July 27, 1993 by Law No. 8689 (COSTA, CHAGAS & SILVESTRE; Ministerio da Saude, 1997).

Sistema Unico de Saude (SUS) – National Health System

The SUS was based on the formulation of a health model geared to the needs of the population trying to rescue the state’s commitment to the well-being, especially in regards to public health by consolidating it as one of the rights of Citizenship. This view reflected the political movement since the Brazilian society was recently out of a military dictatorship where citizenship had never been a principle of government. Cradled by the movement of “direct now”, the company sought to ensure the new constitution the rights and values ​​of democracy and citizenship (Ministerio da Saude, 1997; Ministerio da Saude, 2012).

Despite the SUS have been defined by the Constitution of 1988, it was only regulated September 19, 1990 by Law 8.080. The law defines the operational model of SUS, suggesting their form of organization and operation; some of these concepts will be exposed below (Ministerio da Saude, 1997).

Initially, health begins to be defined in a comprehensive way: “Health has determinant and conditioning factors, among others, food, housing, sanitation, environment, labor, income, education, transport, leisure, and access to essential goods and services: the levels of health of the population express the social and economic organization of the country” (Ministerio da Saude, 1997). The SUS is designed as a set of actions and health services, provided by public bodies, foundations maintained by the government, and federal, state, and local government both direct and indirect. The private sector can participate in a complementary SUS (Ministerio da Saude, 2012).

The Brazilian health system is formed by a complex network of providers and purchasers of services that compete with each other generating a combined public-private financed mainly by private resources. The health system has three subsectors. The public subsector, its services are funded and provided by the federal, state, and local health services; which includes the military. The private subsector (for-profit or not), its services are financed in different ways through public and private resources. Finally, the health insurance subsector with different types of private health plans and insurance policies, and tax subsidies (Ministerio da Saude, 2012).

The public and private components of the system are distinct, but are interconnected, and people can use the services of all three sub-sectors depending on the ease of access or their ability to pay (Ministerio da Saude, 2012).

Since its establishment by Law Organic Health in 1990, the health system has experienced important changes. We can highlight the significant progress made in its universalization mainly due to an important process of decentralization of responsibilities, powers, and resources from the federal to states and municipalities; as opposed the previous model of the health system characterized by marked and financial centralization of decision at the federal level (Ministerio da Saude, 2012).

Principles of SUS

The concept of social security – “an integrated set of initiatives by the government and society to ensure the rights to health, welfare, and social assistance” (CF, art. 194)-is one of the most important innovations incorporated into the constitution promulgated on October 5, 1988. The new concept imposed a radical transformation in the Brazilian health system. First, recognizing health as a social right, and second, setting a new paradigm for state action in the area. This new framework is expressed in two constitutional provisions: (Presidencia da Republica, 1990)

Article 196 – the right of health should be guaranteed “through economic and social policies aimed at reducing the risk of disease and other hazards, and at universal and equal access to actions and services for its promotion, protection, and recovery”; acknowledging therefore, the multiple determination and the close relationship between health and development model (Presidencia da Republica, 1990)

Article 198 – the actions and public health services are organized in a regionalized and hierarchical network, and constitute a unique health system according to the following guidelines:

1) Full care with priority given to preventive activities; without prejudice to assistance services.

2) Decentralization with a single direction in each sphere of government.

3) Community participation. (Presidencia da Republica, 1990)

Universality

“Healthcare is everyone’s right,” as the Federal Constitution states. Of course, it is understood that the state has an obligation to provide health care; it is impossible to keep everyone healthy by law (Presidencia da Republica, 1990).

Integrality

Health care includes both curative and preventative, both for the individual and the collective. In other words, the health needs of individuals (or groups) should be taken into account even if they are not equal to the majority (Presidencia da Republica, 1990).

Equity

Everyone should have equal opportunity to use the health system. Brazil has social and regional disparities so the health needs vary (Presidencia da Republica, 1990).

Community participation

Social control was better regulated by Law 8142. Users participate of the SUS management through Health Conference which happens every four years at all levels, and by the Boards of Health which also are collegiate bodies. The Board of Health has what is called parity; the users have half the seats, the government has a bedroom, and the workers have another room (Brasil, 2011).

Political and Administrative Decentralization

The SUS is available in three levels, also called spheres: national, state, and municipal levels, each with a single command and proper attribution. The municipalities have increasingly assumed an important role in the provision and management of health services. Transfers have become based on population and the type of service offered, and not by the number in care (Brasil, 2011).

Hierarchization and regionalization

Health services are divided into levels of complexity. The primary level should be provided directly to the population, while others should be used only when necessary. Each health service has a catchment area, which is responsible for the health of the population. The services of greater complexity are less numerous and therefore its catchment area is a wider coverage area of several less complex services.

The Health Organic Law also establishes the following principles: (Brasil, 2011)

· Preservation of the autonomy of people in defense of their physical and moral integrity.

· Right to information for people attended to about their health.

· Dissemination of information about the potential of health services and their exercise by the user.

· Use of epidemiology in establishing priorities, allocating resources, and programmatic guidance.

· Integration in executive level of healthcare, environment, and sanitation.

· Combination of financial, technological, material, and human factors for national, state, federal district, and municipalities in the provision of health care to the population.

· Ability resolution services in all levels of care.

· Organization of public services to avoid duplication of means for identical ends.

Consolidating the process of evolution of the public health system, the Federal Constitution of 1988 established the universal and equal access to health care as a right of citizenship (CF, art. 196). The legislation (Law 8080/1990) includes the principles of SUS the “equality of care, without prejudice or privilege of any kind”(article 7, section IV). The law (art. 43) has secured the gratuitous care to prevent that access was hampered by an economic barrier in addition to existing services such as: distance, waiting time, hours of operation, the negative expectation on the host, as well as educational and cultural factors (Ministerio da Saude, 2007; Presidencia da Republica, 1990).

Areas of activity

According to the article 200 of the Federal Constitution, the responsibility of the SUS (Presidencia da Republica,1990):

· Control and monitoring procedures, products and substances of concern for the health and promoting the production of medicines, equipment, immunobiological products, blood products, and other inputs.

· Perform health surveillance and epidemiological as well as the worker health.

· Sort the training of human resources in health.

· Participate in policy formulation and implementation of basic sanitation.

· Increase in your area of expertise the scientific and technological development.

· Supervise and inspect food, drinks, and water, and encompass the control of its nutritional content for human consumption.

· Participate in the supervision and control of production, transport, storage, and use of psychoactive substances and products both toxic and radioactive.

· Collaborate in environmental protection; including that of labor.

Funding

The Brazilian health system is financed through general taxes, social contributions (taxes for specific social programs), direct disbursement, and spending of employers for health care. The funding sources of SUS are the state revenues and social contributions of the federal, state, and municipal budget. Other sources of funding are private out-of-pocket costs and those made ​​by employers. The SUS financing has not been sufficient to ensure stable and adequate financial resources for the public system. Social security contributions have been higher than the proceeds of taxes, which are divided among federal, state, and municipal levels. The SUS has been underfunded (SCHNEIDER, 2008).

The federal level is still responsible for the largest share of funding for SUS; although, the participation of municipalities has been growing over the last ten years.

Payment to providers of health services is done at the government level and is responsible for its management. Regardless of the level of government that runs the payment, SUS uses the same information system for outpatient services, the Outpatient Information System (CIS), and for hospital services, the Hospital Information System (HIS). In the specific case of hospitalizations, although payment for services is decentralized to the level of government responsible for its management, processing of information relating to all admissions financed by public health system is done centrally by the Department of the SUS (DATASUS) agency of the Ministry of Health. The entire public system uses a single price list, defined by MS, for payment to service providers. The trend is that the municipalities assume greater responsibility for the relationship with service providers as they enable the conditions for decentralized management system (SCHNEIDER, 2008; (Brasil, 2011).).

Brazilian Health

Programs

Primary Care

The development of primary or basic care, as it is called in Brazil, has received much attention in the SUS. Driven by the decentralization process and supported by innovative programs, primary care has the goal of providing universal access, and comprehensive services, coordinate, and expand coverage to more complex levels of care, as well as implementing intersectional health promotion and disease prevention. For this, several strategies have been used for the transfer of resources and organizational; in particular, the Program for Community Health Workers and the Family Health Program (PSF) (Pacto pela Saude, 2006).

Programs

· Melhor em casa (Better at home)

People in need of motor rehabilitation, elderly, and chronically ill patients without worsening or post-surgical will have free multidisciplinary care in their homes with care closer to family (Pacto pela Saude, 2006).

The program will also help reduce the lines at hospital emergency care because when there is a medical indication the assistance will be performed at the residence of the patient since there is consent of the family (Pacto pela Saude, 2006).

The “Melhor em casa” is run in partnership with states and municipalities. The program is articulated with the Rede Saúde Toda Hora, released by the federal government to extend assistance, respectively, in primary, and in cases of emergency care in the SUS (Pacto pela Saude, 2006).

·

S.O.S Emergências

(S.O.S Emergencies)

The federal government, along with states, counties, and hospital managers, will promote the core needs of hospitals, improve management, qualify and extend access to users in an emergency, reduce the waiting time, and humanized care. The action begins in 11 large hospitals; which are regional references and have great daily demand. SOS Emergencias work with other urgent and emergency services that make up the Rede Saúde Toda Hora; it is coordinated by the Ministry of Health, and enforced by state and municipal managers. The hospitals should be articulated with the SAMU 192, UPAS 24 hours, stabilization rooms, services of Primary Care, and Melhor em casa. The Rede Saúde Toda Hora will invest $18.8 billion in services until 2014 (Pacto pela Saude, 2006).

· Academia da Saude (Health Academy)

The Program Academia da Saude, created by Ordinance No. 719 on April 7, 2011, has as its main objective to contribute to the promotion of population health from the deployment of poles with infrastructure, equipment, and personnel qualified to guide bodily practices, physical activity, recreation, and healthy lifestyles (Pacto pela Saude, 2006).

· Saude da Familia (Family Health)

Saude da Familia is understood as a strategy for reorienting the care model; it’s operational through the implementation of multidisciplinary teams in primary care units. These teams are responsible for monitoring a number of families located in a defined geographical area. The teams work with the actions of health promotion, prevention, recovery, rehabilitation of diseases and disorders, and in maintaining the health of this community. The responsibility for monitoring families for family health teams need to overcome the limits for primary care in Brazil; especially in the context of SUS (Pacto pela Saude, 2006).

· Doacao de orgaos (Organ Donation)

The Ministry of Health launched a national campaign to encourage organ donation across the country. With the theme “Be an organ donor, be a giver of life”, this year’s edition seeks to educate Brazilians about the importance of organ donation for transplantation (Pacto pela Saude, 2006).

· Farmacia Popular do Brasil (Popular Pharmacy)

The People’s Pharmacy program was developed in Brazil by the federal government for the benefit of the people having easier access to drugs that are considered fundamental; such as: medicines dedicated to common diseases, for example, diabetes. These drugs are offered at low cost. The People’s Pharmacy program works with two lines of action, which are their own units. It has municipalities and states as partners in its development, and co-payment system; having its development partners drugstores and pharmacies. The private pharmacies and drugstores wishing to partner with the People’s Pharmacy program must hold a registration to be regulated within the program (Pacto pela Saude, 2006).

· Human Milk Banks

The network of human milk banks mission is to promote the health of women and children by integrating and building partnerships with federal agencies. In 2011, 158,498 receptors were distributed by 316 different locations in the country (Pacto pela Saude, 2006).

· Cancer Control Program

The objectives of national program for control of cervical cancer and the national breast cancer control are to provide grants to advance the planning of control of these cancers. Both were affirmed as a priority in the national cancer care in 2005 and the pact for health in 2006 (Pacto pela Saude, 2006).

· SAMU 192

SAMU (Mobile Emergency Service) performs accident and emergency services at any place. The service functions 24 hours a day with teams of doctors, nurses, nursing assistants, and first aid specialists who attend traumatic events. Help comes via a free call to the telephone number 192 (Pacto pela Saude, 2006).

· National food and nutrition program

The set of government policies aimed at achieving the universal human right to adequate food and nutrition. This policy aims to guarantee the quality of foods available for consumption in the country, to promote healthy dietary practices, prevention and control of nutritional disorders, and the stimulation of all sectors actions that favor universal access to food (Pacto pela Saude, 2006).

· Back to home

The back to home program, created by the Ministry of Health, is a program of social reintegration for people affected by mental disorders who were in a hospital for a long duration. The objective of this program is to contribute to the process of social inclusion of these people; encouraging the organization and diversification of health care resources and care from social facilitators to ensure their overall well-being and encourage the full exercise of their rights (Pacto pela Saude, 2006).

In Brazil, who does not like paying for medicine or treatment is entitled by law to resort to public health to get them. The SUS (Unified Health System) provides a list of 560 drugs that are distributed free throughout the country for health care according to the Ministry of Health. Such medicines are classified into three groups divided between basic (hypertension and diabetes, etc.), strategic (AIDS, tuberculosis, and leprosy, etc.), and specialized (or expensive) as the type of disease (Pacto pela Saude, 2006).

Only for the latter, the ministry has 147 targeted drugs for rare cases and rare diseases, such as: Alzheimer’s, chronic heart, and lung problems, called “medicine specialist or expensive.” According to the ministry, these remedies are not always consistent with the highest price; most are determined by the level of complexity of the treatment (Pacto pela Saude, 2006).

This peculiarity renders many questions of population and how to get them to understand when there is negative reception by the government. That has happened because you cannot just come up with a prescription on hand to take the medicine. A careful analysis is made by bodies that decide whether or not to grant the benefit (Pacto pela Saude, 2006).

To order the drugs, the patient must first be registered with the SUS. To complete the registration they should take proper documents to the clinic where they can make the request. However, it is not just any unit that can do this because some take place only in a specific delivery for high-cost medications (Pacto pela Saude, 2006).

According to the Ministry of Health, the SUS has 6,100 accredited hospitals, 45,000 primary care units, and 30,300 Family Health Teams (ESF). The system performs 2.8 billion outpatient procedures annually, 19,000 transplants, 236,000 cardiac surgeries, 9.7 million procedures, chemotherapy and radiotherapy, and 11 million hospitalizations (Pacto pela Saude, 2006; Brasil, 2011).

Due to the complexity and size of the continental Brazil, the SUS faces major challenges. Population aging and changing epidemiological profile reinforce the need for constant evaluations, corrections, and innovations for improving the system. Similarly, the advent of new technologies for its pressure and incorporation require that Brazil has a strong health-industrial complex; less technologically dependent on the foreign market. As the production capacity is expanded, is dominant a greater autonomy to set priorities in production and always aiming for offering the better quality of assistance (Brasil, 2011).

To assess the strengths and weaknesses of the health system in Brazil, it is necessary to compare the reality of Brazil with other countries (Brasil, 2011).

Canada

The Canada health system is very popular, but it was not easy to establish it. The Canada health system is called Medicare, but is different from the United State’s Medicare which is only for U.S. citizens over 65 years. In Canada’s Medicare, everyone contributes and therefore everyone has access to health care (Aaron, 2003; Sheils, 1992).

In this system there are no exclusions for age and pre-existing illness, or loss of insurance through the exchange of jobs. Employers have nothing to do with the health system; it is organized directly around the citizen being managed by provincial governments. There is not different treatment for people that have more money; it’s the same treatment for everyone (Aaron, 2003; Sheils, 1992).

A Canadian citizen, with his/her health card, can choose their doctor. The doctors have their own private room and compete with their colleagues for the best service provided. The money from the citizens is in the form of tax collected by the federal government and is passed on proportionally to the provinces. The citizens of one province have coverage in all others, too. He/She also has coverage outside the country for treatments not offered in the country (Aaron, 2003, Sheils, 1992).

United States

Americans over 65 years old or disabled are covered by a system called Medicare, in which the government pays hospitals and doctors who serve the beneficiary. Part of the low income population, uses Medicaid, which is another system funded by the government. A huge part of the population is in a black hole. Many are in an intermediate range because they are not poor enough to receive Medicaid, and not old enough for Medicare. For many Americans, there is no health insurance provided through work and they can not afford a private policy (McGlynn, 2003; Schuster, 1998).

People in the United States do have money to pay for a private plan or have a job that offers health insurance many times. In the U.S., companies can lay off pregnant women and people with cancer. Having a health plan does not guarantee that the person will not have to pay for their medical treatments. Most plans set a limit on annual spending and a deductible that the insurance starts to reimburse only after the patient pays its counterpart. Plans may also refuse to make insurance for patients with a history of chronic disease or pre-existing conditions (McGlynn, 2003; Schuster, 1998).

The majority of Americans don’t have health insurance. There is no National Health System (SUS) in the country; meaning that if people get sick then they will need to sell their car or mortgage their house to pay the hospital bills. Medical expenses are the main reason for personal bankruptcies in the country (McGlynn, 2003; Schuster, 1998).

France

The French healthcare system was considered by the World Health Organization (WHO) as the best in the world. There, the state plays a central role in controlling the relationships between the various financial institutions, doctors, and patients. Since 1996, the Parliament decides on the amount of funds to be allocated to public health insurers, which are linked to more than 60% of French citizens. The rest of the population has special health plans with different costs and coverage tables. In France, there is a total freedom of choice for the patient. People who get sick can decide whether go to a general practitioner or go straight to a specialist. Employees are required to allocate only 0.75% of their income to insurance companies (IMAI, JACOBZONE, & LENAIN, 2000).

England

NHS (National Health Service) is the name of public health system in England; equivalent to the SUS in Brazil. It employs 1.3 million people, serves 1 million patients every 36 hours, and is considered the greatest public health structure in the world. Due to its huge size and complexity, the quality of services may vary depending on the region where you live (Boyle, 2011).

People who are entitled to free treatment:

· Legal residents with permanent residence.

· Refugees.

· Students, enrolled in a course for at least 15 hours per week, on a student visa valid for more than six months and their families.

· Asylum seekers and people with work permit.

The NHS is financed largely by general taxation (including a portion of payments for National Security). The department responsible for the NHS is the UK government, the Ministry of Health, headed by the Health Secretary of the State. (Boyle, 2011).

It can be concluded, over the past few years the health indicators in Brazil report great progress. The Constitution of 1988 established the Unified Health System (SUS), which now has the goal of universal coverage for the entire population. The Ministry of Health and the federal government in partnership with the states and municipalities got the Brazilian health system more efficient, and achieve the goals of coverage and equality. (Boyle, 2011).

Access to health care, as in Brazil, is a right of citizenship. With the exception of the United States, Canada, French and England, who offer a health system with universal access to its citizens. Today, there is no doubt that health care should not be a privilege of the most favored. Diseases and suffering are tenacious and dangerous enemies for any society, that must be taken seriously at the time of distribution of public resources, through of labor for every citizen.

References

 

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