The Brazilian Health System in the face of international typology: a prospective and inevitable discussion

Abstract

In the light of comparative analysis of health systems (HS), this article aims to discuss the Brazilian HS in order to identify promising strategies for its development. Methodologically, based on studies about its formation and its main components, approximation and distance from the three types of HS are discussed: 1-based on universal national services (Beveridgeans); 2-based on compulsory social insurance (Bismarkian); 3-based on voluntary private insurance (Smithians). Brazilian HS is segmented and includes: both Beveridgean aspects, especially PHC (municipalized and heterogeneous), and Smithians elements, such as, private sector, specialized care and hospital. But little is similar to the Bismarckian HS. In its Smithian and Bismarckian aspects, the law of reverse care is more evident, with public funding from the private sector to the wealthiest quartile of the population. For greater rationality, efficiency, equity and universality, it is necessary to invest in the Beveridgean aspects of the Brazilian HS, which is not yet occurring. This means reducing health tax expenditures, expanding and qualifying PHC (via Family Health Strategy - FHS) and specialized and hospital care, regionalizing its management (to reduce inequalities) and increasing the coordinating role of the FHS (perhaps by expanding or modifying the Support Centers for FHS).