Publication:
Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde

dc.contributor.authorGragnolati, Michele
dc.contributor.authorLindelow, Magnus
dc.date.accessioned2013-09-24T22:07:18Z
dc.date.available2013-09-24T22:07:18Z
dc.date.issued2013-06-13
dc.description.abstractIt has been more than 20 years since Brazil's 1988 Constitution formally established the Unified Health System (Sistema Unico de Saude, SUS). Building on reforms that started in the 1980s, the SUS represented a significant break with the past, establishing health care as a fundamental right and duty of the state and initiating a process of fundamentally transforming Brazil's health system to achieve this goal. This report aims to answer two main questions. First is have the SUS reforms transformed the health system as envisaged 20 years ago? Second, have the reforms led to improvements with regard to access to services, financial protection, and health outcomes? In addressing these questions, the report revisits ground covered in previous assessments, but also brings to bear additional or more recent data and places Brazil's health system in an international context. The report shows that the health system reforms can be credited with significant achievements. The report points to some promising directions for health system reforms that will allow Brazil to continue building on the achievements made to date. Although it is possible to reach some broad conclusions, there are many gaps and caveats in the story. A secondary aim of the report is to consider how some of these gaps can be filled through improved monitoring of health system performance and future research. The introduction presents a short review of the history of the SUS, describes the core principles that underpinned the reform, and offers a brief description of the evaluation framework used in the report. Chapter two presents findings on the extent to which the SUS reforms have transformed the health system, focusing on delivery, financing, and governance. Chapter three asks whether the reforms have resulted in improved outcomes with regard to access to services, financial protection, quality, health outcomes, and efficiency. The concluding chapter presents the main findings of the study, discusses some policy directions for addressing the current shortcomings, and identifies areas for further research.en
dc.identifierhttp://documents.worldbank.org/curated/en/2013/01/17899895/twenty-years-health-system-reform-brazil-assessment-sistema-unico-de-saude
dc.identifier.isbn978-0-8213-9843-2
dc.identifier.other10.1596/978-0-8213-9843-2
dc.identifier.urihttps://hdl.handle.net/10986/15801
dc.languageEnglish
dc.language.isoen_US
dc.publisherWashington, DC: World Bank
dc.relation.ispartofseriesDirections in Development--Human Development;
dc.rightsCC BY 3.0 IGO
dc.rights.holderWorld Bank
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/igo
dc.subjectACCESS TO HEALTH SERVICES
dc.subjectACCESS TO SERVICES
dc.subjectAGING
dc.subjectALLOCATIVE EFFICIENCY
dc.subjectANTENATAL CARE
dc.subjectBASIC LEGISLATION
dc.subjectBLOCK GRANT
dc.subjectCANCER PATIENTS
dc.subjectCATASTROPHIC HEALTH EXPENDITURE
dc.subjectCERVICAL CANCER
dc.subjectCESAREAN SECTION
dc.subjectCESAREAN SECTIONS
dc.subjectCHILD MORTALITY
dc.subjectCITIZEN
dc.subjectCLINICAL GUIDELINES
dc.subjectCOMMUNITY HEALTH
dc.subjectCOMMUNITY PARTICIPATION
dc.subjectDEATHS
dc.subjectDELIVERY OF HEALTH CARE
dc.subjectDEMAND FOR HEALTH
dc.subjectDEMAND FOR HEALTH CARE
dc.subjectDEMOGRAPHIC CHANGES
dc.subjectDEMOGRAPHIC TRANSITION
dc.subjectDENTAL CARE
dc.subjectDETERMINANTS OF HEALTH
dc.subjectDEVELOPING COUNTRIES
dc.subjectDIABETES
dc.subjectDISEASE CONTROL
dc.subjectDISEASES
dc.subjectDOCTORS
dc.subjectECONOMIC GROWTH
dc.subjectECONOMIES OF SCALE
dc.subjectELDERLY
dc.subjectELDERLY POPULATION
dc.subjectEMERGENCY CARE
dc.subjectEMPLOYMENT
dc.subjectEPIDEMIOLOGY
dc.subjectEQUITABLE ACCESS
dc.subjectEQUITABLE ACCESS TO HEALTH CARE
dc.subjectESSENTIAL DRUGS
dc.subjectFAMILIES
dc.subjectFAMILY HEALTH
dc.subjectFAMILY INCOME
dc.subjectFEE-FOR-SERVICE
dc.subjectFEE-FOR-SERVICE PAYMENT
dc.subjectFINANCIAL PROTECTION
dc.subjectFINANCING OF HEALTH CARE
dc.subjectFUNDAMENTAL RIGHT
dc.subjectGENERAL PRACTICE
dc.subjectGROSS DOMESTIC PRODUCT
dc.subjectHEALTH CARE
dc.subjectHEALTH CARE DELIVERY
dc.subjectHEALTH CARE FACILITIES
dc.subjectHEALTH CARE FINANCING
dc.subjectHEALTH CARE NEEDS
dc.subjectHEALTH CARE NETWORKS
dc.subjectHEALTH CARE SERVICES
dc.subjectHEALTH CARE SYSTEM
dc.subjectHEALTH CENTERS
dc.subjectHEALTH ECONOMICS
dc.subjectHEALTH EDUCATION
dc.subjectHEALTH EXPENDITURE
dc.subjectHEALTH EXPENDITURES
dc.subjectHEALTH FACILITIES
dc.subjectHEALTH FINANCING
dc.subjectHEALTH INFORMATION
dc.subjectHEALTH INSURANCE
dc.subjectHEALTH INSURANCE PLANS
dc.subjectHEALTH INTERVENTIONS
dc.subjectHEALTH NEEDS
dc.subjectHEALTH ORGANIZATION
dc.subjectHEALTH OUTCOMES
dc.subjectHEALTH PLAN
dc.subjectHEALTH PLANS
dc.subjectHEALTH PROFESSIONS
dc.subjectHEALTH PROMOTION
dc.subjectHEALTH PROVIDERS
dc.subjectHEALTH REFORM
dc.subjectHEALTH RESEARCH
dc.subjectHEALTH SECTOR
dc.subjectHEALTH SECTOR REFORM
dc.subjectHEALTH SERVICES
dc.subjectHEALTH STATUS
dc.subjectHEALTH STRATEGY
dc.subjectHEALTH SYSTEM
dc.subjectHEALTH SYSTEM EFFICIENCY
dc.subjectHEALTH SYSTEM GOALS
dc.subjectHEALTH SYSTEM PERFORMANCE
dc.subjectHEALTH SYSTEM REFORM
dc.subjectHEALTH SYSTEMS
dc.subjectHEALTH WORKERS
dc.subjectHIV/AIDS
dc.subjectHOME CARE
dc.subjectHOSPITAL ADMISSION
dc.subjectHOSPITAL ADMISSIONS
dc.subjectHOSPITAL BEDS
dc.subjectHOSPITAL CAPACITY
dc.subjectHOSPITAL CARE
dc.subjectHOSPITAL DELIVERIES
dc.subjectHOSPITAL MANAGEMENT
dc.subjectHOSPITAL SERVICES
dc.subjectHOSPITALIZATION
dc.subjectHOSPITALS
dc.subjectHOUSEHOLD INCOME
dc.subjectHOUSEHOLD SURVEYS
dc.subjectHUMAN DEVELOPMENT
dc.subjectHUMAN RESOURCES
dc.subjectHYPERTENSION
dc.subjectIMMUNIZATION
dc.subjectIMMUNIZATIONS
dc.subjectIMMUNODEFICIENCY
dc.subjectIMPORTANT POLICY
dc.subjectINCOME
dc.subjectINCOME COUNTRIES
dc.subjectINCOME DISTRIBUTION
dc.subjectINCOME GROUPS
dc.subjectINEQUALITIES IN HEALTH STATUS
dc.subjectINFANT
dc.subjectINFANT MORTALITY
dc.subjectINFORMATION SYSTEM
dc.subjectINPATIENT CARE
dc.subjectINSTITUTIONAL MECHANISMS
dc.subjectINTEGRATION
dc.subjectINTERNATIONAL ORGANIZATIONS
dc.subjectLAWS
dc.subjectLEGAL STATUS
dc.subjectLEVEL OF HEALTH SPENDING
dc.subjectLIFE EXPECTANCY
dc.subjectLIVE BIRTHS
dc.subjectLOCAL CAPACITY
dc.subjectMANDATES
dc.subjectMATERNAL MORTALITY
dc.subjectMEDICAL CARE
dc.subjectMEDICAL PROCEDURES
dc.subjectMEDICAL RECORDS
dc.subjectMEDICAL SUPPLIES
dc.subjectMEDICAL TECHNOLOGY
dc.subjectMEDICINES
dc.subjectMENTAL HEALTH
dc.subjectMENTAL HEALTH SERVICES
dc.subjectMIGRATION
dc.subjectMINISTRY OF HEALTH
dc.subjectMORBIDITY
dc.subjectMORTALITY
dc.subjectNATIONAL COUNCIL
dc.subjectNATIONAL HEALTH
dc.subjectNATIONAL LEVEL
dc.subjectNONGOVERNMENTAL ORGANIZATIONS
dc.subjectNORMAL DELIVERIES
dc.subjectORAL HEALTH
dc.subjectPATIENT
dc.subjectPATIENTS
dc.subjectPHYSICIAN
dc.subjectPHYSICIANS
dc.subjectPOCKET PAYMENTS
dc.subjectPOLICY MAKERS
dc.subjectPOLICY RESEARCH
dc.subjectPRIMARY CARE
dc.subjectPRIMARY HEALTH CARE
dc.subjectPRIMARY HEALTH CARE SERVICES
dc.subjectPRIMARY HEALTH CARE SYSTEM
dc.subjectPRIVATE HEALTH INSURANCE
dc.subjectPRIVATE HOSPITALS
dc.subjectPRIVATE SECTOR
dc.subjectPRIVATE SECTORS
dc.subjectPRIVATE SPENDING
dc.subjectPROGRESS
dc.subjectPROVIDER PAYMENT
dc.subjectPROVIDERS OF HEALTH CARE
dc.subjectPROVISION OF HEALTH CARE
dc.subjectPUBLIC EXPENDITURE
dc.subjectPUBLIC EXPENDITURE MANAGEMENT
dc.subjectPUBLIC HEALTH
dc.subjectPUBLIC HEALTH PROGRAMS
dc.subjectPUBLIC HEALTH SYSTEM
dc.subjectPUBLIC HOSPITAL
dc.subjectPUBLIC PERCEPTIONS
dc.subjectPUBLIC PROVIDERS
dc.subjectPUBLIC SECTOR
dc.subjectPUBLIC SERVICES
dc.subjectPUBLIC SPENDING
dc.subjectQUALITY ASSURANCE
dc.subjectQUALITY IMPROVEMENT
dc.subjectQUALITY OF CARE
dc.subjectQUALITY OF HEALTH
dc.subjectQUALITY OF HEALTH CARE
dc.subjectRATE OF GROWTH
dc.subjectREFERRAL SYSTEMS
dc.subjectREGIONAL NETWORKS
dc.subjectRESEARCH COMMUNITY
dc.subjectRESOURCE ALLOCATION
dc.subjectRESPECT
dc.subjectRISK FACTORS
dc.subjectSAFE WATER
dc.subjectSANITATION
dc.subjectSCREENING
dc.subjectSERVICE DELIVERY
dc.subjectSERVICE PROVISION
dc.subjectSHARE OF HEALTH SPENDING
dc.subjectSMOKING
dc.subjectSOCIAL PARTICIPATION
dc.subjectSOCIAL POLICY
dc.subjectSOCIAL SECURITY
dc.subjectSYPHILIS
dc.subjectTECHNICAL CAPACITY
dc.subjectTECHNICAL RESOURCES
dc.subjectTUBERCULOSIS
dc.subjectUNIVERSAL ACCESS
dc.subjectUSE OF HEALTH SERVICES
dc.subjectWASTE
dc.subjectWORKERS
dc.subjectWORLD HEALTH ORGANIZATION
dc.titleTwenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúdeen
dspace.entity.typePublication
okr.date.disclosure2013-06-21
okr.doctypePublications & Research::Publication
okr.doctypePublications & Research::Publication
okr.docurlhttp://documents.worldbank.org/curated/en/2013/01/17899895/twenty-years-health-system-reform-brazil-assessment-sistema-unico-de-saude
okr.globalpracticeSocial Protection and Labor
okr.globalpracticeHealth, Nutrition, and Population
okr.identifier.doi10.1596/978-0-8213-9843-2
okr.identifier.externaldocumentum000442464_20130621122542
okr.identifier.internaldocumentum17899895
okr.identifier.report78682
okr.language.supporteden
okr.pdfurlhttp://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2013/06/21/000442464_20130621122542/Rendered/PDF/786820PUB0EPI10Box0377351B00PUBLIC0.pdfen
okr.region.administrativeLatin America & Caribbean
okr.region.countryBrazil
okr.topicPensions and Retirement Systems
okr.topicHealth Economics and Finance
okr.topicHealth, Nutrition and Population::Population Policies
okr.topicHealth Monitoring and Evaluation
okr.topicHealth Systems Development and Reform
okr.topicSocial Protections and Labor
okr.unitHuman Development (LCSHD)
okr.volume1 of 1
relation.isAuthorOfPublication2a5c6056-1d11-5665-8932-f780910c879e
relation.isAuthorOfPublicationd6df2a53-bb3c-5376-8494-5d7b3af636f6
relation.isAuthorOfPublication.latestForDiscovery2a5c6056-1d11-5665-8932-f780910c879e
relation.isSeriesOfPublication706db16a-e556-46f0-8283-1b4a4b88645c
relation.isSeriesOfPublication.latestForDiscovery706db16a-e556-46f0-8283-1b4a4b88645c
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