Publication: Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde
Date
2013-06-13
ISSN
Published
2013-06-13
Author(s)
Abstract
It 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.
Citation
“Gragnolati, Michele; Lindelow, Magnus; Couttolenc, Bernard. 2013. Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde. Directions in Development--Human Development;. © Washington, DC: World Bank. http://openknowledge.worldbank.org/handle/10986/15801 License: CC BY 3.0 IGO.”
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