Isabela Soares Santos

O mix público-privado no Sistema de Saúde Brasileiro: financiamento, oferta e utilização de serviços de saúde

This paper analyzes the public-private mix in the Brazilian Health System from the perspective of health care delivery, utilization and financing. Moreover, this quantitative study based on secondary data from official databases contemplates the subsidies granted by the government to the private sector. It shows the existence of some inequalities favoring the population having private health plans, a result of the peculiar participation of the private sector in the Brazilian Health System not only offering supplementary care but duplicating the coverage offered by the public system (called SUS). The analysis is made on the basis of the classification of public-private mix in Health Systems developed by the OECD in 2004, that helps understanding the kinds of inequalities occurring in each type of public-private mix. The inequalities that occur in the Brazilian system must be understood as the result of the duplicated coverage offered by the private market and of the weak public funding for the SUS while granting important subsidies to the private sector.

A utilização de serviços de saúde por sistema de financiamento

This article analyses, from micro-data of the National Sample Household Survey (PNAD/IBGE) from 1998 and 2003, the utilisation of health services according to different financing systems. In other words, it analyses if this utilisation has been done through the National Health System SUS (public and universal health insurance, financed by taxes), through private health insurance (premiums paid by the insured population and/or their employers) or through out-of-pocket payments. The main results are: 1) SUS finances most of inpatient and outpatient utilisation and its participation has strongly increased from 1998 to 2003; 2) although the absolute number of outpatient utilisation made through the three systems has increased, SUS expansion has been much stronger (it increased 44%) and it corresponded to a slower increase (6,2%) of out-of-pocket utilisation and 3) SUS is the main financing system of the two extremes of complexity of health care: primary care and high complexity services.

Uma análise da progressividade do financiamento do Sistema Único de Saúde (SUS)

This article analyzes the level of progressivity in taxes financing the Brazilian Unified National Health System (SUS). Distribution of the tax burden financing the SUS was calculated using micro-data from the Household Budgets Survey, 2002-2003. The Kakwani index, which shows a tax systems level of progressivity, was calculated. The Kakwani index of public financing was -0.008, and SUS financing was nearly proportional to income. From a social justice perspective this is highly undesirable in a society like Brazil, with a Gini index of 0.57. The system should be clearly progressive in order to counterbalance the countrys extreme income concentration.

A situação atual do mercado da saúde suplementar no Brasil e apontamentos para o futuro

This paper presents an overview of the Brazilian private health plan market over the period 2000-2006. The current situation is analyzed with respect to the profile of private insurance companies, health plans and beneficiaries and some possible trends that were identified in the study are emphasized. The increase of employer group-plans as a work-related benefit and the reduction of individual plans are discussed. Although the market is restricted to only a few companies, there are more people covered by local plans than by plans offering coverage on a national basis. Finally, the paper approaches aspects related to the financial resources, among them the governmental incentive for the health area, and points to the need of further studies for a better understanding of the supplementary healthcare market.

Evidência sobre o mix público-privado em países com cobertura duplicada: agravamento das iniquidades e da segmentação em sistemas nacionais de saúde

This paper seeks to identify the potential negative effects of private health insurance on the universality of National Health Systems. It systematizes the operational concepts of the public-private mix model and presents the results from international research into duplicated and supplementary coverage that shows that universality is negatively affected by inequities derived from duplicated coverage though not from supplementary coverage. It demystifies the supplementary nature of private health insurance as the villain in the Brazilian healthcare system and recommends that public policies should be fully oriented to improving the public health system instead of private health insurance.

Aplicação da metodologia de relacionamento probabilístico de base de dados para a identificação de óbitos em estudos epidemiológicos

A crescente disponibilidade de dados de abrangencia nacional, organizados em distintos sistemas de informacao, requer o desenvolvimento de metodologias para o relacionamento de variaveis constantes em diferentes bases de dados. Este artigo descreve e analisa a metodologia utilizada no relacionamento das bases de dados nacionais do Sistema de Informacao de Beneficiarios (planos privados de assistencia a saude) e do Sistema de Informacao de Mortalidade. Foram analisados os registros de obitos e os registros de beneficiarios no ano de 2004, identificando-se 92.566 obitos em beneficiarios de planos privados de saude. O rigor na especificidade, em detrimento da sensibilidade do metodo empregado, nao gerou vieses de selecao que pudessem comprometer as analises resultantes. A razao de mortalidade padronizada aponta a subestimacao do numero de obitos, alem de evidenciar diferencas no risco de morte entre as populacoes analisadas; no entanto, as diferentes situacoes de vida e saude a que estao expostas podem ter interferido nos resultados.

Sistema universal de saúde e cobertura universal: desvendando pressupostos e estratégias

In recent years the international debate about universality in health has been marked by a polarization between ideas based on a universal system, and notions proposing universal health coverage. The concept of universal coverage has been disseminated by international organizations and has been incorporated into health system reforms in several developing countries, including some in Latin America. This article explores the assumptions and strategies related to the proposal of universal health coverage. Firstly, a comparison is provided of the models of universal health coverage and universal health systems. This is followed by a contextualization of the international debate, including examples of different health systems. Finally, the implications of the proposal of universal coverage for the right to health in Brazil are discussed. The analysis of different concepts of universality and the experiences of different countries shows that health insurance-based models, either social or private, are not as satisfactory as public, universal health systems. Greater understanding about ongoing international projects is essential in order to identify the possibilities represented by the consolidation of the Unified Health System (SUS) in Brazil, as well as the risks of dismantling the SUS.

Realocar a oferta do SUS para atender problemas do futuro: o caso do trauma no Brasil

RESUMO Este artigo analisa o perfil dos recursos fisicos de saude disponiveis no Brasil, utilizando o exemplo do trauma de alta complexidade para subsidiar o debate da reorganizacao da rede de servicos de saude. Utilizou-se o Cadastro Nacional de Estabelecimentos de Saude de 2013. Identificou-se que ha insuficiencia quantitativa e baixa oferta na distribuicao geografica de leitos de Unidades de Terapia Intensiva, de hospitais de grande porte e das oito estruturas exigidas pelo Ministerio da Saude para habilitacao dos estabelecimentos ao atendimento do trauma de alta complexidade. A aquisicao de uma estrutura nos estabelecimentos que ja possuem as outras sete aumentaria esta oferta de 30 para 80 do numero de municipios com atendimento ao trauma de alta complexidade.

Direito à saúde e austeridade fiscal: o caso brasileiro em perspectiva internacional

The article analyzes the implications of the austerity policy in Brazil on the guarantee of universal social rights, focusing on the financing of the Unified Health System (SUS) and the right to health. The effects of the Brazilian austerity policy are analyzed in an international perspective, based on evidence produced in different contexts, identified from a literature review, in order to base the arguments developed in the article. Information on the fiscal austerity measures being implemented in Brazil is presented and its likely impacts on social protection in the country are analyzed in a context of significant economic recession. The austerity policy adopted in Brazil is not universal, since it does not affect all Brazilian society equally, nor does it have temporary effects, since it is not focused on reducing the momentary imbalance in public accounts. Its main objective is to promote the reduction of the size of the Brazilian State. Finally, we show alternative paths to the fiscal austerity policy that has been used to tackle the economic crisis. The authors argue by a national development project that is necessarily linked to social protection for the universe of citizens and based on values of solidarity.