20 anos de Construção do Sistema de Saúde no Brasil: Uma Análise do Sistema Único de Saúde

Com a criação do Sistema Único de Saúde (SUS) há mais de 20 anos, o Brasil foi um dos primeiros e poucos países de fora da OCDE (Organização para a Cooperação e Desenvolvimento Econômico) a prever em sua legislação o acesso universal aos serviços de saúde, reconhecendo a saúde como direito do cidadão e dever do Estado. Com base nesta experiência e mesmo com todas as dificuldades inerentes a um país em desenvolvimento, o Brasil é hoje referência internacional na área de saúde pública e exemplo para outros países que buscam sistemas de saúde com maior equidade. Passados mais de 20 anos desde sua criação, qual é a marca do SUS? O livro "20 Anos de Construção do SUS no Brasil" recentemente lançado pelo Banco Mundial busca analisar esta trajetória. O texto conclui que a construção do Sistema Único de Saúde do Brasil lançou os alicerces de um sistema de saúde melhor para o País contribuindo para o bem-estar social e a melhoria da qualidade de vida da população. Entre os progressos trazidos pelo SUS destacam-se a reestruturação profunda dos mecanismos de integração do sistema, o processo constante de descentralização e compartilhamento das responsabilidades entre união, estados e municípios, assim como o aumento gradual dos gastos públicos para o financiamento do setor.

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.

More than 20 years have passed since the Brazilian Sistema nico de Sade (Unified Health System or SUS) was formally established by the 1988 Constitution. The SUS reforms established health as a fundamental right and duty of the state and started a process of fundamentally transforming Brazil's health system to achieve this goal. Twenty Years of Health System Reform in Brazil asks what has been achieved and what challenges remain in accomplishing the goals that were established in 1988. Specifically, it assesses whether the SUS reforms have transformed the health system as envisaged and whether they have improved access to services, financial protection, and health outcomes. The report finds that the health system reforms provided the foundation for the improved health system that Brazil has today. These improvements include an impressive expansion of utilization and access to primary care, a profound restructuring of the health system, the steady decentralization of responsibilities to municipalities, and a growth in government health care spending.