Twenty Years Of Health System Reform In Brazil

It has been over twenty years since the Brazilian Sistema Único de Saúde (Unified Health System or SUS) was formally established by the 1988 Constitution. The impetus for the SUS came in part from rising costs and a crisis in the social security system that preceded the reforms, but also from a broad-based political movement calling for democratization and improved social rights. Building on reforms that started in the 1980s, the SUS was based on three overarching principles: (i) universal access to health services, with health defined as a citizen’s right and an obligation of the state; (ii) equality of access to health care; and (iii) integrality (comprehensiveness) and continuity of care; along with several other guiding ideas, including decentralization, increased participation, and evidence-based prioritization. The SUS reform established health a fundamental right and duty of the state, and started a process of fundamentally transforming Brazil’s health system to achieve this goal. So, what has been achieved since the SUS was established? And what challenges remain in achieving the goals that were established in 1988? These questions are the focus of this report. Specifically, it seeks to assess whether the SUS reforms have managed to transform the health system as envisaged more than 20 years ago, and whether the reforms have led to improved outcomes in terms of access to services, financial protection, and health status. Any effort to assess the performance of a health system runs into a host of challenges concerning the definition of boundaries of the “health system”, the outcomes that the assessment should focus on, data sources and quality, and the role of policies and reforms in understanding how the performance of the health system has changed over time. Building on an extensive literature on health system assessment, this report is based on a simple framework that specifies a set of health system “building blocks”, which affect a number of intermediate outcomes such as access, quality and efficiency, which, in turn, contribute to final outcomes, including health status, financial protection, and satisfaction. Based on this framework, the report starts by looking at how key building blocks of Brazil’s health system have changed over time and then moves on to review performance in terms of intermediate and final outcomes.

In 1988, a new health care system, the Sistema Único de Saúde (Unified Health Care System or SUS) was formally established in Brazil. The system was intended, among other goals, to provide universal access to health care services and to redefine health as a citizen's right and a duty of the state. A Right to Health explores how these goals have unfolded within an urban peripheral community located on the edges of the northeastern city of Fortaleza. Focusing on the decade 1998–2008 and the impact of health care reforms on one low-income neighborhood, Jessica Jerome documents the tensions that arose between the ideals of the reforms and their entanglement with pervasive socioeconomic inequality, neoliberal economic policy, and generational tension with the community. Using ethnographic and historical research, the book traces the history of political activism in the community, showing that, since the community's formation in the early 1930s, residents have consistently fought for health care services. In so doing, Jerome develops a multilayered portrait of urban peripheral life and suggests that the notion of health care as a right of each citizen plays a major role not only in the way in which health care is allocated, but, perhaps more importantly, in how health care is understood and experienced.

This book investigates how the technology used by telehealth services shapes our healthcare, and how we, as humans, collectively change and shape the technology and services used in healthcare. Based on extensive field research on telehealth services in Australia and Brazil, the book reveals some surprisingly obvious conclusions about our powers to shape the society.

This book examines the construction of an innovation system in Brazil’s health industries over the past twenty years. The authors argue that the system has remained active despite the crisis that began in 2014. However, while this crisis has led to cuts in public spending on research and health, it has simultaneously tended to stimulate local production and invention aimed at reducing deficits in the trade in medicines and medical technologies. The contributors highlight a model combining the acquisition of new technologies with social justice and the right to health, and introduce new concepts of the “nationalization” of technologies, innovation through copying and civil society regulation of industrial property and of the medicinal drug market.

Abstract: Health systems are not just about improving health: good ones also ensure that people are protected from the financial consequences of receiving medical care. Anecdotal evidence suggests health systems often perform badly in this respect, apparently with devastating consequences for households, especially poor ones and near-poor ones. Two principal methods have been used to measure financial protection in health. Both relate a household's out-of-pocket spending to a threshold defined in terms of living standards in the absence of the spending: the first defines spending as catastrophic if it exceeds a certain percentage of the living standards measure; the second defines spending as impoverishing if it makes the difference between a household being above and below the poverty line. The paper provides an overview of the methods and issues arising in each case, and presents empirical work in the area of financial protection in health, including the impacts of government policy. The paper also reviews a recent critique of the methods used to measure financial protection.

Analyzes institutional bypasses, a strategy to promote change and implement reforms in developing countries.

Over the past 20 years, social scientists, government officials, and investors have expressed mounting interest in the BRICS countries, which include Brazil, Russia, India, China and South Africa. These countries are widely viewed as both key actors in the global economy and important regional powers. The Political Economy of the BRICS Countries is a three-volume set that aims to address various crucial issues regarding these countries.Volume 1 analyzes whether economic growth in the BRICS countries has been broad-based and promoted equitable economic and social outcomes. The authors examine specific dimensions of growth in these five economies that constrain their ability to act effectively and cohesively in international affairs.Volume 2 considers how the BRICS have affected global economic governance and the international political economy.Volume 3 provides various approaches to economic informality in the BRICS. Moreover, the chapters deal with several connections between informality and important political, economic, and institutional phenomena such as economic globalization and international aid, economic development, political regimes, social capital, political networks and political participation, labor market rules, and social policy preferences.The BRICS countries have attracted rising attention over the past two decades. The volumes provide an in-depth analysis of various key issues regarding these countries and chart a course for future research.