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

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collection.link.135
https://openknowledge.worldbank.org/handle/10986/6000
collection.link.336
https://openknowledge.worldbank.org/handle/10986/32464
collection.name.135
Portuguese PDFs Available
collection.name.336
Directions in Development
dc.contributor.author
Gragnolati, Michele
dc.contributor.author
Lindelow, Magnus
dc.contributor.author
Couttolenc, Bernard
dc.date.accessioned
2013-09-24T22:07:18Z
dc.date.available
2013-09-24T22:07:18Z
dc.date.issued
2013-06-13
dc.date.lastModified
2021-04-23T14:03:22Z
dc.description.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.
en
dc.identifier
http://documents.worldbank.org/curated/en/2013/01/17899895/twenty-years-health-system-reform-brazil-assessment-sistema-unico-de-saude
dc.identifier.isbn
978-0-8213-9843-2
dc.identifier.other
10.1596/978-0-8213-9843-2
dc.identifier.uri
http://hdl.handle.net/10986/15801
dc.language
English
dc.language.iso
en_US
dc.publisher
Washington, DC: World Bank
dc.relation.ispartofseries
Directions in Development--Human Development;
dc.rights
CC BY 3.0 IGO
dc.rights.holder
World Bank
dc.rights.uri
http://creativecommons.org/licenses/by/3.0/igo
dc.subject
ACCESS TO HEALTH SERVICES
dc.subject
ACCESS TO SERVICES
dc.subject
AGING
dc.subject
ALLOCATIVE EFFICIENCY
dc.subject
ANTENATAL CARE
dc.subject
BASIC LEGISLATION
dc.subject
BLOCK GRANT
dc.subject
CANCER PATIENTS
dc.subject
CATASTROPHIC HEALTH EXPENDITURE
dc.subject
CERVICAL CANCER
dc.subject
CESAREAN SECTION
dc.subject
CESAREAN SECTIONS
dc.subject
CHILD MORTALITY
dc.subject
CITIZEN
dc.subject
CLINICAL GUIDELINES
dc.subject
COMMUNITY HEALTH
dc.subject
COMMUNITY PARTICIPATION
dc.subject
DEATHS
dc.subject
DELIVERY OF HEALTH CARE
dc.subject
DEMAND FOR HEALTH
dc.subject
DEMAND FOR HEALTH CARE
dc.subject
DEMOGRAPHIC CHANGES
dc.subject
DEMOGRAPHIC TRANSITION
dc.subject
DENTAL CARE
dc.subject
DETERMINANTS OF HEALTH
dc.subject
DEVELOPING COUNTRIES
dc.subject
DIABETES
dc.subject
DISEASE CONTROL
dc.subject
DISEASES
dc.subject
DOCTORS
dc.subject
ECONOMIC GROWTH
dc.subject
ECONOMIES OF SCALE
dc.subject
ELDERLY
dc.subject
ELDERLY POPULATION
dc.subject
EMERGENCY CARE
dc.subject
EMPLOYMENT
dc.subject
EPIDEMIOLOGY
dc.subject
EQUITABLE ACCESS
dc.subject
EQUITABLE ACCESS TO HEALTH CARE
dc.subject
ESSENTIAL DRUGS
dc.subject
FAMILIES
dc.subject
FAMILY HEALTH
dc.subject
FAMILY INCOME
dc.subject
FEE-FOR-SERVICE
dc.subject
FEE-FOR-SERVICE PAYMENT
dc.subject
FINANCIAL PROTECTION
dc.subject
FINANCING OF HEALTH CARE
dc.subject
FUNDAMENTAL RIGHT
dc.subject
GENERAL PRACTICE
dc.subject
GROSS DOMESTIC PRODUCT
dc.subject
HEALTH CARE
dc.subject
HEALTH CARE DELIVERY
dc.subject
HEALTH CARE FACILITIES
dc.subject
HEALTH CARE FINANCING
dc.subject
HEALTH CARE NEEDS
dc.subject
HEALTH CARE NETWORKS
dc.subject
HEALTH CARE SERVICES
dc.subject
HEALTH CARE SYSTEM
dc.subject
HEALTH CENTERS
dc.subject
HEALTH ECONOMICS
dc.subject
HEALTH EDUCATION
dc.subject
HEALTH EXPENDITURE
dc.subject
HEALTH EXPENDITURES
dc.subject
HEALTH FACILITIES
dc.subject
HEALTH FINANCING
dc.subject
HEALTH INFORMATION
dc.subject
HEALTH INSURANCE
dc.subject
HEALTH INSURANCE PLANS
dc.subject
HEALTH INTERVENTIONS
dc.subject
HEALTH NEEDS
dc.subject
HEALTH ORGANIZATION
dc.subject
HEALTH OUTCOMES
dc.subject
HEALTH PLAN
dc.subject
HEALTH PLANS
dc.subject
HEALTH PROFESSIONS
dc.subject
HEALTH PROMOTION
dc.subject
HEALTH PROVIDERS
dc.subject
HEALTH REFORM
dc.subject
HEALTH RESEARCH
dc.subject
HEALTH SECTOR
dc.subject
HEALTH SECTOR REFORM
dc.subject
HEALTH SERVICES
dc.subject
HEALTH STATUS
dc.subject
HEALTH STRATEGY
dc.subject
HEALTH SYSTEM
dc.subject
HEALTH SYSTEM EFFICIENCY
dc.subject
HEALTH SYSTEM GOALS
dc.subject
HEALTH SYSTEM PERFORMANCE
dc.subject
HEALTH SYSTEM REFORM
dc.subject
HEALTH SYSTEMS
dc.subject
HEALTH WORKERS
dc.subject
HIV/AIDS
dc.subject
HOME CARE
dc.subject
HOSPITAL ADMISSION
dc.subject
HOSPITAL ADMISSIONS
dc.subject
HOSPITAL BEDS
dc.subject
HOSPITAL CAPACITY
dc.subject
HOSPITAL CARE
dc.subject
HOSPITAL DELIVERIES
dc.subject
HOSPITAL MANAGEMENT
dc.subject
HOSPITAL SERVICES
dc.subject
HOSPITALIZATION
dc.subject
HOSPITALS
dc.subject
HOUSEHOLD INCOME
dc.subject
HOUSEHOLD SURVEYS
dc.subject
HUMAN DEVELOPMENT
dc.subject
HUMAN RESOURCES
dc.subject
HYPERTENSION
dc.subject
IMMUNIZATION
dc.subject
IMMUNIZATIONS
dc.subject
IMMUNODEFICIENCY
dc.subject
IMPORTANT POLICY
dc.subject
INCOME
dc.subject
INCOME COUNTRIES
dc.subject
INCOME DISTRIBUTION
dc.subject
INCOME GROUPS
dc.subject
INEQUALITIES IN HEALTH STATUS
dc.subject
INFANT
dc.subject
INFANT MORTALITY
dc.subject
INFORMATION SYSTEM
dc.subject
INPATIENT CARE
dc.subject
INSTITUTIONAL MECHANISMS
dc.subject
INTEGRATION
dc.subject
INTERNATIONAL ORGANIZATIONS
dc.subject
LAWS
dc.subject
LEGAL STATUS
dc.subject
LEVEL OF HEALTH SPENDING
dc.subject
LIFE EXPECTANCY
dc.subject
LIVE BIRTHS
dc.subject
LOCAL CAPACITY
dc.subject
MANDATES
dc.subject
MATERNAL MORTALITY
dc.subject
MEDICAL CARE
dc.subject
MEDICAL PROCEDURES
dc.subject
MEDICAL RECORDS
dc.subject
MEDICAL SUPPLIES
dc.subject
MEDICAL TECHNOLOGY
dc.subject
MEDICINES
dc.subject
MENTAL HEALTH
dc.subject
MENTAL HEALTH SERVICES
dc.subject
MIGRATION
dc.subject
MINISTRY OF HEALTH
dc.subject
MORBIDITY
dc.subject
MORTALITY
dc.subject
NATIONAL COUNCIL
dc.subject
NATIONAL HEALTH
dc.subject
NATIONAL LEVEL
dc.subject
NONGOVERNMENTAL ORGANIZATIONS
dc.subject
NORMAL DELIVERIES
dc.subject
ORAL HEALTH
dc.subject
PATIENT
dc.subject
PATIENTS
dc.subject
PHYSICIAN
dc.subject
PHYSICIANS
dc.subject
POCKET PAYMENTS
dc.subject
POLICY MAKERS
dc.subject
POLICY RESEARCH
dc.subject
PRIMARY CARE
dc.subject
PRIMARY HEALTH CARE
dc.subject
PRIMARY HEALTH CARE SERVICES
dc.subject
PRIMARY HEALTH CARE SYSTEM
dc.subject
PRIVATE HEALTH INSURANCE
dc.subject
PRIVATE HOSPITALS
dc.subject
PRIVATE SECTOR
dc.subject
PRIVATE SECTORS
dc.subject
PRIVATE SPENDING
dc.subject
PROGRESS
dc.subject
PROVIDER PAYMENT
dc.subject
PROVIDERS OF HEALTH CARE
dc.subject
PROVISION OF HEALTH CARE
dc.subject
PUBLIC EXPENDITURE
dc.subject
PUBLIC EXPENDITURE MANAGEMENT
dc.subject
PUBLIC HEALTH
dc.subject
PUBLIC HEALTH PROGRAMS
dc.subject
PUBLIC HEALTH SYSTEM
dc.subject
PUBLIC HOSPITAL
dc.subject
PUBLIC PERCEPTIONS
dc.subject
PUBLIC PROVIDERS
dc.subject
PUBLIC SECTOR
dc.subject
PUBLIC SERVICES
dc.subject
PUBLIC SPENDING
dc.subject
QUALITY ASSURANCE
dc.subject
QUALITY IMPROVEMENT
dc.subject
QUALITY OF CARE
dc.subject
QUALITY OF HEALTH
dc.subject
QUALITY OF HEALTH CARE
dc.subject
RATE OF GROWTH
dc.subject
REFERRAL SYSTEMS
dc.subject
REGIONAL NETWORKS
dc.subject
RESEARCH COMMUNITY
dc.subject
RESOURCE ALLOCATION
dc.subject
RESPECT
dc.subject
RISK FACTORS
dc.subject
SAFE WATER
dc.subject
SANITATION
dc.subject
SCREENING
dc.subject
SERVICE DELIVERY
dc.subject
SERVICE PROVISION
dc.subject
SHARE OF HEALTH SPENDING
dc.subject
SMOKING
dc.subject
SOCIAL PARTICIPATION
dc.subject
SOCIAL POLICY
dc.subject
SOCIAL SECURITY
dc.subject
SYPHILIS
dc.subject
TECHNICAL CAPACITY
dc.subject
TECHNICAL RESOURCES
dc.subject
TUBERCULOSIS
dc.subject
UNIVERSAL ACCESS
dc.subject
USE OF HEALTH SERVICES
dc.subject
WASTE
dc.subject
WORKERS
dc.subject
WORLD HEALTH ORGANIZATION
dc.title
Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde
en
okr.date.disclosure
2013-06-21
okr.doctype
Publications & Research :: Publication
okr.doctype
Publications & Research :: Publication
okr.docurl
http://documents.worldbank.org/curated/en/2013/01/17899895/twenty-years-health-system-reform-brazil-assessment-sistema-unico-de-saude
okr.globalpractice
Social Protection and Labor
okr.globalpractice
Health, Nutrition, and Population
okr.googlescholar.linkpresent
yes
okr.identifier.doi
10.1596/978-0-8213-9843-2
okr.identifier.externaldocumentum
000442464_20130621122542
okr.identifier.internaldocumentum
17899895
okr.identifier.report
78682
okr.language.supported
en
okr.pdfurl
http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2013/06/21/000442464_20130621122542/Rendered/PDF/786820PUB0EPI10Box0377351B00PUBLIC0.pdf
en
okr.region.administrative
Latin America & Caribbean
okr.region.country
Brazil
okr.topic
Pensions and Retirement Systems
okr.topic
Health Economics and Finance
okr.topic
Health, Nutrition and Population :: Population Policies
okr.topic
Health Monitoring and Evaluation
okr.topic
Health Systems Development and Reform
okr.topic
Social Protections and Labor
okr.unit
Human Development (LCSHD)
okr.volume
1 of 1

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