Brazilian health sector financing is organized mainly through the Unified Health System (SUS), a public health system established by the Federal Constitution of 1988. The SUS provides free medical care to all citizens and permanent residents. In addition to the SUS, the private sector plays an important role in the health service financing and delivery.
Despite public financing, out-of-pocket expenditure remains high
Three levels of government fund the SUS: federal, state and municipal. Decentralization of funding allows local governments to adapt their health services to the specific needs of their populations. The federal government transfers resources to states and municipalities through different mechanisms, such as the National Health Fund. Distribution criteria for these funds include factors such as population, health need and state and municipal fiscal capacity.
Remaining challenges are being addressed
The government has enacted reforms, such as strengthening primary care and amending the Fiscal Responsibility Act (to allow greater transparency in resource use). Both are positive steps to move towards a more sustainable and efficient health system.
