Healthcare in Brazil

The current legal provisions governing the operation of the health system, instituted in 1996, seek to shift responsibility for administration of the SUS to municipal governments, with technical and financial cooperation from the federal government and states. Another regionalization initiative is the creation of health consortia, which pools the resources of several neighbouring municipalities. A vital instrument of support for regionalization is the project for strengthening and reorganizing the SUS.

Procedures for the registration, control, and labelling of foods are established under federal legislation, which assigns specific responsibilities to the health and agriculture sectors. In the health sector, health inspection activities have been decentralized to the state and municipal governments. The environmental policy derives from specific legislation and from the Constitution of 1988.

The Program for Investment in the Health Industrial Complex (PROCIS) is an example of the medical-industrial complex in Brazil.[3] This promotes medical research, development and treatment within Brazil.[4]

The main strategy for strengthening primary healthcare is the Family Health Program, introduced by the municipal health secretariats in collaboration with the states and the Ministry of Public Health. The federal government supplies technical support and transfers funding through Piso de Atenção Básica. Disease prevention and control activities follow guidelines established by technical experts in the Ministry of Public Health. The National Epidemiology Center (CENEPI), an agency of the National Health Foundation (FUNASA) coordinates the national epidemiological surveillance system, which provides information about and analysis of the national health situation.

In 2014 there were 6,706 hospitals in Brazil. Over 50% of hospitals are found in 5 states: São Paulo, Minas Gerais, Bahia, Rio de Janeiro and Paraná.

Throughout the country, 78% of hospitals practice general medicine while 16% are specialized and 6% provide outpatient care only.[5]

In 2012, 66% of the country's hospitals, 70% of its 485,000 hospital beds, and 87% of its 723 specialized hospitals belonged to the private sector. In the area of diagnostic support and therapy, 95% of the 7,318 establishments were also private. 73% of the 41,000 ambulatory care facilities were operated by the public.[6]

The public hospital infrastructure required hospitals to be spread over a territory of 8.516 million square kilometres (3.288 million square miles). As such, the public hospital infrastructure relies on a vast network of small hospitals. Over 55% of public hospitals have less than 50 beds.

Hospital beds in the public sector were distributed as follows: surgery (21%), clinical medicine (30%), pediatrics (17%), obstetrics (14%), psychiatry (11%) and other areas (7%). In the same year, 43% of public hospital beds, and half the hospital admissions were in municipal establishments.

Since 1999, the Ministry of Public Health has been carrying out a health surveillance project in Amazonia that includes epidemiological and environmental health surveillance, indigenous health and disease control components. With US 600 million dollars from a World Bank loan, efforts are being made to improve the operational infrastructure, training of human resources and research studies. An estimated 25% of the population is covered by at least one form of health insurance; 75% of the insurance plans are offered by commercial operators and companies with self-managed plans.

Brazil is among the greatest consumers markets for drugs, accounting for 3.5% share of the world market. To expand the access of the population to drugs, incentives have been offered for marketing generic products, which cost an average of 40% less than brand-name products. In 2000, there were 14 industries authorized to produce generic drugs and about 200 registered generic drugs were being produced in 601 different forms. In 1998, the National Drug Policy was approved, whose purpose is to ensure safety, efficacy, and quality of drugs, as well as the promotion of rational use and access for the population to essential products. The responsibility for national production of immunobiologicals is entrusted to public laboratories; which have a long-standing tradition of producing vaccines and are for use in official programs. The Ministry of Public Health invested some US$120 million in the development of the capacity of these laboratories. In 2000, the supply of products was sufficient to meet the need for heterologous use, such as those used in the vaccines against tuberculosis, measles, diphtheria, tetanus, whooping cough, yellow fever, and rabies. In 1999, quality control of the transfused blood consisted of 26 coordinating centers and by 44 regional centers.

In 1999, the country had some 237,000 physicians, 145,000 dentists, 77,000 nurses, 26,000 dietitians and 56,000 veterinarians. The national average ratio was of 14 physicians per 10,000 population. In 1999, of the 665,000 professional positions, 65% were occupied by physicians, followed by nurses (11%), dentists (8%), pharmacists, biochemists (3.2%), physical therapists (2.8%) and by other professionals (10%). An estimated 1.4 million health sector jobs are occupied by technical and auxiliary personnel.

In 2009, for the first time, more new medical licenses were given for women than for men.[7]

As of 2010, the country had 364,757 physicians.[7] In 2011, there were 1.95 physicians for each 1000 Brazilians, with higher concentrations in south, southeast and mid-western than in north and northeastern Brazil.[7] For each 1000 private health insurance users there were 7.6 occupied work posts for physicians, and for each 1000 Sistema Único de Saúde users, there were 1.95 occupied work posts for physicians, making an average of 3.33 occupied work posts for physicians for each 1000 Brazilians.[7] As to the distribution of physicians between medical specialties and primary care, 55.09% of all Brazilian physicians were specialists.[7]

In 1998 national health expenditure amounted to US$62,000 million, which corresponded to nearly 7.9% of GDP. Of that total, public spending accounted for 41.2% and private expenditure accounted for 58.8%. In per capita terms, public spending is estimated at US$158 and private expenditure at US$225.

Technical cooperation projects are carried out with different countries, as well as with the World Bank and UNESCO among many others. International foundations also provide direct financing for projects or individuals. Brazil is also engaged in an intense exchange with the Mercosul countries, aimed at establishing common health regulations.[8]