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

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,...

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Main Authors:	Gragnolati, Michele, Lindelow, Magnus, Couttolenc, Bernard
Format:	Publication
Language:	English en_US
Published:	Washington, DC: World Bank 2013
Subjects:	ACCESS TO HEALTH SERVICES ACCESS TO SERVICES AGING ALLOCATIVE EFFICIENCY ANTENATAL CARE BASIC LEGISLATION BLOCK GRANT CANCER PATIENTS CATASTROPHIC HEALTH EXPENDITURE CERVICAL CANCER CESAREAN SECTION CESAREAN SECTIONS CHILD MORTALITY CITIZEN CLINICAL GUIDELINES COMMUNITY HEALTH COMMUNITY PARTICIPATION DEATHS DELIVERY OF HEALTH CARE DEMAND FOR HEALTH DEMAND FOR HEALTH CARE DEMOGRAPHIC CHANGES DEMOGRAPHIC TRANSITION DENTAL CARE DETERMINANTS OF HEALTH DEVELOPING COUNTRIES DIABETES DISEASE CONTROL DISEASES DOCTORS ECONOMIC GROWTH ECONOMIES OF SCALE ELDERLY ELDERLY POPULATION EMERGENCY CARE EMPLOYMENT EPIDEMIOLOGY EQUITABLE ACCESS EQUITABLE ACCESS TO HEALTH CARE ESSENTIAL DRUGS FAMILIES FAMILY HEALTH FAMILY INCOME FEE-FOR-SERVICE FEE-FOR-SERVICE PAYMENT FINANCIAL PROTECTION FINANCING OF HEALTH CARE FUNDAMENTAL RIGHT GENERAL PRACTICE GROSS DOMESTIC PRODUCT HEALTH CARE HEALTH CARE DELIVERY HEALTH CARE FACILITIES HEALTH CARE FINANCING HEALTH CARE NEEDS HEALTH CARE NETWORKS HEALTH CARE SERVICES HEALTH CARE SYSTEM HEALTH CENTERS HEALTH ECONOMICS HEALTH EDUCATION HEALTH EXPENDITURE HEALTH EXPENDITURES HEALTH FACILITIES HEALTH FINANCING HEALTH INFORMATION HEALTH INSURANCE HEALTH INSURANCE PLANS HEALTH INTERVENTIONS HEALTH NEEDS HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH PLAN HEALTH PLANS HEALTH PROFESSIONS HEALTH PROMOTION HEALTH PROVIDERS HEALTH REFORM HEALTH RESEARCH HEALTH SECTOR HEALTH SECTOR REFORM HEALTH SERVICES HEALTH STATUS HEALTH STRATEGY HEALTH SYSTEM HEALTH SYSTEM EFFICIENCY HEALTH SYSTEM GOALS HEALTH SYSTEM PERFORMANCE HEALTH SYSTEM REFORM HEALTH SYSTEMS HEALTH WORKERS HIV/AIDS HOME CARE HOSPITAL ADMISSION HOSPITAL ADMISSIONS HOSPITAL BEDS HOSPITAL CAPACITY HOSPITAL CARE HOSPITAL DELIVERIES HOSPITAL MANAGEMENT HOSPITAL SERVICES HOSPITALIZATION HOSPITALS HOUSEHOLD INCOME HOUSEHOLD SURVEYS HUMAN DEVELOPMENT HUMAN RESOURCES HYPERTENSION IMMUNIZATION IMMUNIZATIONS IMMUNODEFICIENCY IMPORTANT POLICY INCOME INCOME COUNTRIES INCOME DISTRIBUTION INCOME GROUPS INEQUALITIES IN HEALTH STATUS INFANT INFANT MORTALITY INFORMATION SYSTEM INPATIENT CARE INSTITUTIONAL MECHANISMS INTEGRATION INTERNATIONAL ORGANIZATIONS LAWS LEGAL STATUS LEVEL OF HEALTH SPENDING LIFE EXPECTANCY LIVE BIRTHS LOCAL CAPACITY MANDATES MATERNAL MORTALITY MEDICAL CARE MEDICAL PROCEDURES MEDICAL RECORDS MEDICAL SUPPLIES MEDICAL TECHNOLOGY MEDICINES MENTAL HEALTH MENTAL HEALTH SERVICES MIGRATION MINISTRY OF HEALTH MORBIDITY MORTALITY NATIONAL COUNCIL NATIONAL HEALTH NATIONAL LEVEL NONGOVERNMENTAL ORGANIZATIONS NORMAL DELIVERIES ORAL HEALTH PATIENT PATIENTS PHYSICIAN PHYSICIANS POCKET PAYMENTS POLICY MAKERS POLICY RESEARCH PRIMARY CARE PRIMARY HEALTH CARE PRIMARY HEALTH CARE SERVICES PRIMARY HEALTH CARE SYSTEM PRIVATE HEALTH INSURANCE PRIVATE HOSPITALS PRIVATE SECTOR PRIVATE SECTORS PRIVATE SPENDING PROGRESS PROVIDER PAYMENT PROVIDERS OF HEALTH CARE PROVISION OF HEALTH CARE PUBLIC EXPENDITURE PUBLIC EXPENDITURE MANAGEMENT PUBLIC HEALTH PUBLIC HEALTH PROGRAMS PUBLIC HEALTH SYSTEM PUBLIC HOSPITAL PUBLIC PERCEPTIONS PUBLIC PROVIDERS PUBLIC SECTOR PUBLIC SERVICES PUBLIC SPENDING QUALITY ASSURANCE QUALITY IMPROVEMENT QUALITY OF CARE QUALITY OF HEALTH QUALITY OF HEALTH CARE RATE OF GROWTH REFERRAL SYSTEMS REGIONAL NETWORKS RESEARCH COMMUNITY RESOURCE ALLOCATION RESPECT RISK FACTORS SAFE WATER SANITATION SCREENING SERVICE DELIVERY SERVICE PROVISION SHARE OF HEALTH SPENDING SMOKING SOCIAL PARTICIPATION SOCIAL POLICY SOCIAL SECURITY SYPHILIS TECHNICAL CAPACITY TECHNICAL RESOURCES TUBERCULOSIS UNIVERSAL ACCESS USE OF HEALTH SERVICES WASTE WORKERS WORLD HEALTH ORGANIZATION
Online Access:	http://documents.worldbank.org/curated/en/2013/01/17899895/twenty-years-health-system-reform-brazil-assessment-sistema-unico-de-saude http://hdl.handle.net/10986/15801

id	okr-10986-15801
recordtype	oai_dc
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	English en_US
topic	ACCESS TO HEALTH SERVICES ACCESS TO SERVICES AGING ALLOCATIVE EFFICIENCY ANTENATAL CARE BASIC LEGISLATION BLOCK GRANT CANCER PATIENTS CATASTROPHIC HEALTH EXPENDITURE CERVICAL CANCER CESAREAN SECTION CESAREAN SECTIONS CHILD MORTALITY CITIZEN CLINICAL GUIDELINES COMMUNITY HEALTH COMMUNITY PARTICIPATION DEATHS DELIVERY OF HEALTH CARE DEMAND FOR HEALTH DEMAND FOR HEALTH CARE DEMOGRAPHIC CHANGES DEMOGRAPHIC TRANSITION DENTAL CARE DETERMINANTS OF HEALTH DEVELOPING COUNTRIES DIABETES DISEASE CONTROL DISEASES DOCTORS ECONOMIC GROWTH ECONOMIES OF SCALE ELDERLY ELDERLY POPULATION EMERGENCY CARE EMPLOYMENT EPIDEMIOLOGY EQUITABLE ACCESS EQUITABLE ACCESS TO HEALTH CARE ESSENTIAL DRUGS FAMILIES FAMILY HEALTH FAMILY INCOME FEE-FOR-SERVICE FEE-FOR-SERVICE PAYMENT FINANCIAL PROTECTION FINANCING OF HEALTH CARE FUNDAMENTAL RIGHT GENERAL PRACTICE GROSS DOMESTIC PRODUCT HEALTH CARE HEALTH CARE DELIVERY HEALTH CARE FACILITIES HEALTH CARE FINANCING HEALTH CARE NEEDS HEALTH CARE NETWORKS HEALTH CARE SERVICES HEALTH CARE SYSTEM HEALTH CENTERS HEALTH ECONOMICS HEALTH EDUCATION HEALTH EXPENDITURE HEALTH EXPENDITURES HEALTH FACILITIES HEALTH FINANCING HEALTH INFORMATION HEALTH INSURANCE HEALTH INSURANCE PLANS HEALTH INTERVENTIONS HEALTH NEEDS HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH PLAN HEALTH PLANS HEALTH PROFESSIONS HEALTH PROMOTION HEALTH PROVIDERS HEALTH REFORM HEALTH RESEARCH HEALTH SECTOR HEALTH SECTOR REFORM HEALTH SERVICES HEALTH STATUS HEALTH STRATEGY HEALTH SYSTEM HEALTH SYSTEM EFFICIENCY HEALTH SYSTEM GOALS HEALTH SYSTEM PERFORMANCE HEALTH SYSTEM REFORM HEALTH SYSTEMS HEALTH WORKERS HIV/AIDS HOME CARE HOSPITAL ADMISSION HOSPITAL ADMISSIONS HOSPITAL BEDS HOSPITAL CAPACITY HOSPITAL CARE HOSPITAL DELIVERIES HOSPITAL MANAGEMENT HOSPITAL SERVICES HOSPITALIZATION HOSPITALS HOUSEHOLD INCOME HOUSEHOLD SURVEYS HUMAN DEVELOPMENT HUMAN RESOURCES HYPERTENSION IMMUNIZATION IMMUNIZATIONS IMMUNODEFICIENCY IMPORTANT POLICY INCOME INCOME COUNTRIES INCOME DISTRIBUTION INCOME GROUPS INEQUALITIES IN HEALTH STATUS INFANT INFANT MORTALITY INFORMATION SYSTEM INPATIENT CARE INSTITUTIONAL MECHANISMS INTEGRATION INTERNATIONAL ORGANIZATIONS LAWS LEGAL STATUS LEVEL OF HEALTH SPENDING LIFE EXPECTANCY LIVE BIRTHS LOCAL CAPACITY MANDATES MATERNAL MORTALITY MEDICAL CARE MEDICAL PROCEDURES MEDICAL RECORDS MEDICAL SUPPLIES MEDICAL TECHNOLOGY MEDICINES MENTAL HEALTH MENTAL HEALTH SERVICES MIGRATION MINISTRY OF HEALTH MORBIDITY MORTALITY NATIONAL COUNCIL NATIONAL HEALTH NATIONAL LEVEL NONGOVERNMENTAL ORGANIZATIONS NORMAL DELIVERIES ORAL HEALTH PATIENT PATIENTS PHYSICIAN PHYSICIANS POCKET PAYMENTS POLICY MAKERS POLICY RESEARCH PRIMARY CARE PRIMARY HEALTH CARE PRIMARY HEALTH CARE SERVICES PRIMARY HEALTH CARE SYSTEM PRIVATE HEALTH INSURANCE PRIVATE HOSPITALS PRIVATE SECTOR PRIVATE SECTORS PRIVATE SPENDING PROGRESS PROVIDER PAYMENT PROVIDERS OF HEALTH CARE PROVISION OF HEALTH CARE PUBLIC EXPENDITURE PUBLIC EXPENDITURE MANAGEMENT PUBLIC HEALTH PUBLIC HEALTH PROGRAMS PUBLIC HEALTH SYSTEM PUBLIC HOSPITAL PUBLIC PERCEPTIONS PUBLIC PROVIDERS PUBLIC SECTOR PUBLIC SERVICES PUBLIC SPENDING QUALITY ASSURANCE QUALITY IMPROVEMENT QUALITY OF CARE QUALITY OF HEALTH QUALITY OF HEALTH CARE RATE OF GROWTH REFERRAL SYSTEMS REGIONAL NETWORKS RESEARCH COMMUNITY RESOURCE ALLOCATION RESPECT RISK FACTORS SAFE WATER SANITATION SCREENING SERVICE DELIVERY SERVICE PROVISION SHARE OF HEALTH SPENDING SMOKING SOCIAL PARTICIPATION SOCIAL POLICY SOCIAL SECURITY SYPHILIS TECHNICAL CAPACITY TECHNICAL RESOURCES TUBERCULOSIS UNIVERSAL ACCESS USE OF HEALTH SERVICES WASTE WORKERS WORLD HEALTH ORGANIZATION
spellingShingle	ACCESS TO HEALTH SERVICES ACCESS TO SERVICES AGING ALLOCATIVE EFFICIENCY ANTENATAL CARE BASIC LEGISLATION BLOCK GRANT CANCER PATIENTS CATASTROPHIC HEALTH EXPENDITURE CERVICAL CANCER CESAREAN SECTION CESAREAN SECTIONS CHILD MORTALITY CITIZEN CLINICAL GUIDELINES COMMUNITY HEALTH COMMUNITY PARTICIPATION DEATHS DELIVERY OF HEALTH CARE DEMAND FOR HEALTH DEMAND FOR HEALTH CARE DEMOGRAPHIC CHANGES DEMOGRAPHIC TRANSITION DENTAL CARE DETERMINANTS OF HEALTH DEVELOPING COUNTRIES DIABETES DISEASE CONTROL DISEASES DOCTORS ECONOMIC GROWTH ECONOMIES OF SCALE ELDERLY ELDERLY POPULATION EMERGENCY CARE EMPLOYMENT EPIDEMIOLOGY EQUITABLE ACCESS EQUITABLE ACCESS TO HEALTH CARE ESSENTIAL DRUGS FAMILIES FAMILY HEALTH FAMILY INCOME FEE-FOR-SERVICE FEE-FOR-SERVICE PAYMENT FINANCIAL PROTECTION FINANCING OF HEALTH CARE FUNDAMENTAL RIGHT GENERAL PRACTICE GROSS DOMESTIC PRODUCT HEALTH CARE HEALTH CARE DELIVERY HEALTH CARE FACILITIES HEALTH CARE FINANCING HEALTH CARE NEEDS HEALTH CARE NETWORKS HEALTH CARE SERVICES HEALTH CARE SYSTEM HEALTH CENTERS HEALTH ECONOMICS HEALTH EDUCATION HEALTH EXPENDITURE HEALTH EXPENDITURES HEALTH FACILITIES HEALTH FINANCING HEALTH INFORMATION HEALTH INSURANCE HEALTH INSURANCE PLANS HEALTH INTERVENTIONS HEALTH NEEDS HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH PLAN HEALTH PLANS HEALTH PROFESSIONS HEALTH PROMOTION HEALTH PROVIDERS HEALTH REFORM HEALTH RESEARCH HEALTH SECTOR HEALTH SECTOR REFORM HEALTH SERVICES HEALTH STATUS HEALTH STRATEGY HEALTH SYSTEM HEALTH SYSTEM EFFICIENCY HEALTH SYSTEM GOALS HEALTH SYSTEM PERFORMANCE HEALTH SYSTEM REFORM HEALTH SYSTEMS HEALTH WORKERS HIV/AIDS HOME CARE HOSPITAL ADMISSION HOSPITAL ADMISSIONS HOSPITAL BEDS HOSPITAL CAPACITY HOSPITAL CARE HOSPITAL DELIVERIES HOSPITAL MANAGEMENT HOSPITAL SERVICES HOSPITALIZATION HOSPITALS HOUSEHOLD INCOME HOUSEHOLD SURVEYS HUMAN DEVELOPMENT HUMAN RESOURCES HYPERTENSION IMMUNIZATION IMMUNIZATIONS IMMUNODEFICIENCY IMPORTANT POLICY INCOME INCOME COUNTRIES INCOME DISTRIBUTION INCOME GROUPS INEQUALITIES IN HEALTH STATUS INFANT INFANT MORTALITY INFORMATION SYSTEM INPATIENT CARE INSTITUTIONAL MECHANISMS INTEGRATION INTERNATIONAL ORGANIZATIONS LAWS LEGAL STATUS LEVEL OF HEALTH SPENDING LIFE EXPECTANCY LIVE BIRTHS LOCAL CAPACITY MANDATES MATERNAL MORTALITY MEDICAL CARE MEDICAL PROCEDURES MEDICAL RECORDS MEDICAL SUPPLIES MEDICAL TECHNOLOGY MEDICINES MENTAL HEALTH MENTAL HEALTH SERVICES MIGRATION MINISTRY OF HEALTH MORBIDITY MORTALITY NATIONAL COUNCIL NATIONAL HEALTH NATIONAL LEVEL NONGOVERNMENTAL ORGANIZATIONS NORMAL DELIVERIES ORAL HEALTH PATIENT PATIENTS PHYSICIAN PHYSICIANS POCKET PAYMENTS POLICY MAKERS POLICY RESEARCH PRIMARY CARE PRIMARY HEALTH CARE PRIMARY HEALTH CARE SERVICES PRIMARY HEALTH CARE SYSTEM PRIVATE HEALTH INSURANCE PRIVATE HOSPITALS PRIVATE SECTOR PRIVATE SECTORS PRIVATE SPENDING PROGRESS PROVIDER PAYMENT PROVIDERS OF HEALTH CARE PROVISION OF HEALTH CARE PUBLIC EXPENDITURE PUBLIC EXPENDITURE MANAGEMENT PUBLIC HEALTH PUBLIC HEALTH PROGRAMS PUBLIC HEALTH SYSTEM PUBLIC HOSPITAL PUBLIC PERCEPTIONS PUBLIC PROVIDERS PUBLIC SECTOR PUBLIC SERVICES PUBLIC SPENDING QUALITY ASSURANCE QUALITY IMPROVEMENT QUALITY OF CARE QUALITY OF HEALTH QUALITY OF HEALTH CARE RATE OF GROWTH REFERRAL SYSTEMS REGIONAL NETWORKS RESEARCH COMMUNITY RESOURCE ALLOCATION RESPECT RISK FACTORS SAFE WATER SANITATION SCREENING SERVICE DELIVERY SERVICE PROVISION SHARE OF HEALTH SPENDING SMOKING SOCIAL PARTICIPATION SOCIAL POLICY SOCIAL SECURITY SYPHILIS TECHNICAL CAPACITY TECHNICAL RESOURCES TUBERCULOSIS UNIVERSAL ACCESS USE OF HEALTH SERVICES WASTE WORKERS WORLD HEALTH ORGANIZATION Gragnolati, Michele Lindelow, Magnus Couttolenc, Bernard Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde
geographic_facet	Latin America & Caribbean Brazil
relation	Directions in Development--Human Development;
description	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.
format	Publications & Research :: Publication
author	Gragnolati, Michele Lindelow, Magnus Couttolenc, Bernard
author_facet	Gragnolati, Michele Lindelow, Magnus Couttolenc, Bernard
author_sort	Gragnolati, Michele
title	Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde
title_short	Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde
title_full	Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde
title_fullStr	Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde
title_full_unstemmed	Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde
title_sort	twenty years of health system reform in brazil : an assessment of the sistema único de saúde
publisher	Washington, DC: World Bank
publishDate	2013
url	http://documents.worldbank.org/curated/en/2013/01/17899895/twenty-years-health-system-reform-brazil-assessment-sistema-unico-de-saude http://hdl.handle.net/10986/15801
_version_	1764431217477812224
spelling	okr-10986-158012021-04-23T14:03:22Z Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde Gragnolati, Michele Lindelow, Magnus Couttolenc, Bernard ACCESS TO HEALTH SERVICES ACCESS TO SERVICES AGING ALLOCATIVE EFFICIENCY ANTENATAL CARE BASIC LEGISLATION BLOCK GRANT CANCER PATIENTS CATASTROPHIC HEALTH EXPENDITURE CERVICAL CANCER CESAREAN SECTION CESAREAN SECTIONS CHILD MORTALITY CITIZEN CLINICAL GUIDELINES COMMUNITY HEALTH COMMUNITY PARTICIPATION DEATHS DELIVERY OF HEALTH CARE DEMAND FOR HEALTH DEMAND FOR HEALTH CARE DEMOGRAPHIC CHANGES DEMOGRAPHIC TRANSITION DENTAL CARE DETERMINANTS OF HEALTH DEVELOPING COUNTRIES DIABETES DISEASE CONTROL DISEASES DOCTORS ECONOMIC GROWTH ECONOMIES OF SCALE ELDERLY ELDERLY POPULATION EMERGENCY CARE EMPLOYMENT EPIDEMIOLOGY EQUITABLE ACCESS EQUITABLE ACCESS TO HEALTH CARE ESSENTIAL DRUGS FAMILIES FAMILY HEALTH FAMILY INCOME FEE-FOR-SERVICE FEE-FOR-SERVICE PAYMENT FINANCIAL PROTECTION FINANCING OF HEALTH CARE FUNDAMENTAL RIGHT GENERAL PRACTICE GROSS DOMESTIC PRODUCT HEALTH CARE HEALTH CARE DELIVERY HEALTH CARE FACILITIES HEALTH CARE FINANCING HEALTH CARE NEEDS HEALTH CARE NETWORKS HEALTH CARE SERVICES HEALTH CARE SYSTEM HEALTH CENTERS HEALTH ECONOMICS HEALTH EDUCATION HEALTH EXPENDITURE HEALTH EXPENDITURES HEALTH FACILITIES HEALTH FINANCING HEALTH INFORMATION HEALTH INSURANCE HEALTH INSURANCE PLANS HEALTH INTERVENTIONS HEALTH NEEDS HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH PLAN HEALTH PLANS HEALTH PROFESSIONS HEALTH PROMOTION HEALTH PROVIDERS HEALTH REFORM HEALTH RESEARCH HEALTH SECTOR HEALTH SECTOR REFORM HEALTH SERVICES HEALTH STATUS HEALTH STRATEGY HEALTH SYSTEM HEALTH SYSTEM EFFICIENCY HEALTH SYSTEM GOALS HEALTH SYSTEM PERFORMANCE HEALTH SYSTEM REFORM HEALTH SYSTEMS HEALTH WORKERS HIV/AIDS HOME CARE HOSPITAL ADMISSION HOSPITAL ADMISSIONS HOSPITAL BEDS HOSPITAL CAPACITY HOSPITAL CARE HOSPITAL DELIVERIES HOSPITAL MANAGEMENT HOSPITAL SERVICES HOSPITALIZATION HOSPITALS HOUSEHOLD INCOME HOUSEHOLD SURVEYS HUMAN DEVELOPMENT HUMAN RESOURCES HYPERTENSION IMMUNIZATION IMMUNIZATIONS IMMUNODEFICIENCY IMPORTANT POLICY INCOME INCOME COUNTRIES INCOME DISTRIBUTION INCOME GROUPS INEQUALITIES IN HEALTH STATUS INFANT INFANT MORTALITY INFORMATION SYSTEM INPATIENT CARE INSTITUTIONAL MECHANISMS INTEGRATION INTERNATIONAL ORGANIZATIONS LAWS LEGAL STATUS LEVEL OF HEALTH SPENDING LIFE EXPECTANCY LIVE BIRTHS LOCAL CAPACITY MANDATES MATERNAL MORTALITY MEDICAL CARE MEDICAL PROCEDURES MEDICAL RECORDS MEDICAL SUPPLIES MEDICAL TECHNOLOGY MEDICINES MENTAL HEALTH MENTAL HEALTH SERVICES MIGRATION MINISTRY OF HEALTH MORBIDITY MORTALITY NATIONAL COUNCIL NATIONAL HEALTH NATIONAL LEVEL NONGOVERNMENTAL ORGANIZATIONS NORMAL DELIVERIES ORAL HEALTH PATIENT PATIENTS PHYSICIAN PHYSICIANS POCKET PAYMENTS POLICY MAKERS POLICY RESEARCH PRIMARY CARE PRIMARY HEALTH CARE PRIMARY HEALTH CARE SERVICES PRIMARY HEALTH CARE SYSTEM PRIVATE HEALTH INSURANCE PRIVATE HOSPITALS PRIVATE SECTOR PRIVATE SECTORS PRIVATE SPENDING PROGRESS PROVIDER PAYMENT PROVIDERS OF HEALTH CARE PROVISION OF HEALTH CARE PUBLIC EXPENDITURE PUBLIC EXPENDITURE MANAGEMENT PUBLIC HEALTH PUBLIC HEALTH PROGRAMS PUBLIC HEALTH SYSTEM PUBLIC HOSPITAL PUBLIC PERCEPTIONS PUBLIC PROVIDERS PUBLIC SECTOR PUBLIC SERVICES PUBLIC SPENDING QUALITY ASSURANCE QUALITY IMPROVEMENT QUALITY OF CARE QUALITY OF HEALTH QUALITY OF HEALTH CARE RATE OF GROWTH REFERRAL SYSTEMS REGIONAL NETWORKS RESEARCH COMMUNITY RESOURCE ALLOCATION RESPECT RISK FACTORS SAFE WATER SANITATION SCREENING SERVICE DELIVERY SERVICE PROVISION SHARE OF HEALTH SPENDING SMOKING SOCIAL PARTICIPATION SOCIAL POLICY SOCIAL SECURITY SYPHILIS TECHNICAL CAPACITY TECHNICAL RESOURCES TUBERCULOSIS UNIVERSAL ACCESS USE OF HEALTH SERVICES WASTE WORKERS WORLD HEALTH ORGANIZATION 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. 2013-09-24T22:07:18Z 2013-09-24T22:07:18Z 2013-06-13 http://documents.worldbank.org/curated/en/2013/01/17899895/twenty-years-health-system-reform-brazil-assessment-sistema-unico-de-saude 978-0-8213-9843-2 10.1596/978-0-8213-9843-2 http://hdl.handle.net/10986/15801 English en_US Directions in Development--Human Development; CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo World Bank Washington, DC: World Bank Publications & Research :: Publication Publications & Research :: Publication Latin America & Caribbean Brazil

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

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