How the Healthcare System Works in the Biggest Country of South America: Brazil

Fernanda Furtado Sparrenberger, MD

It was my first day working as a physician, after six years of medical school. I always loved Family Medicine and had the privilege of working in one of the Family Health Strategy (ESF) clinics in my hometown where I’ve lived my whole life. So, I am going to talk about the healthcare system in Brazil, which is mainly composed of The Sistema Único de Saúde (SUS) – the Unified Health System in Brazil.

The SUS is Brazil’s public healthcare system which provides healthcare services to the entire population, regardless of their ability to pay. SUS operates under the principle of universal healthcare coverage, meaning that all Brazilian citizens and legal residents have the right to access healthcare services provided by the system.

ESF is a cornerstone of Brazil’s public healthcare system. It is a clinic system that aims to provide comprehensive primary healthcare services to individuals and families in their communities with a focus on prevention, health promotion, and disease management.

I was nervous and apprehensive on my first day, so I found it very helpful that the ESF operates through multidisciplinary teams composed of doctors, nurses, nurse assistants, dentists, and Community Health Workers (CHWs). As a team, we were responsible for providing care to a specific geographic area, usually covering a certain number of families, and the nurses knew their patients very well. These team members were responsible for the health care of about 4,000 people in this region of the city.

ESF also places a strong emphasis on preventive care and health promotion activities, such as immunizations, prenatal care, family planning, nutrition education, and screening for chronic diseases like diabetes and hypertension.

While ESF teams provide a wide range of primary care services, they also serve as the gateway to the broader healthcare system. They refer patients to secondary and tertiary care facilities when necessary for specialized treatment or procedures.

We also utilize electronic health records to facilitate communication and coordination of care among team members and other healthcare providers within the SUS network. If we need to refer a more critical patient to the hospital, we can use public hospitals.

Public hospitals play a central role in the SUS network, collaborating with primary care units, specialized clinics, and other healthcare providers. They ensure continuity of care for patients. They also participate in referral networks, where patients can be referred for specialized care or procedures not available at primary care facilities.

Although on paper, it is an amazing program, we have a lot of challenges in the day-to-day work with SUS. One of the most significant challenges facing the public health system in Brazil is the issue of underfunding and insufficient resources. Despite its universal coverage mandate and comprehensive scope of services, SUS often struggles to meet the healthcare needs of Brazil’s large and diverse population due to limited financial resources. SUS is funded primarily through government allocations from federal, state, and municipal budgets, as well as contributions from social security taxes.

Budget constraints and competing priorities often lead to insufficient funding for healthcare, limiting the availability of resources for essential services, infrastructure upgrades, and healthcare workforce development.

When patients need a specialist, primary care physicians face shortages of professionals. This is especially true in underserved regions. Additionally, some factors such as low salaries, inadequate working conditions, and few career advancement opportunities discourage specialists from public services in favor of private systems.

Similar to other healthcare systems worldwide, waiting times to see specialized doctors within SUS can sometimes be lengthy, particularly for nonemergency or elective procedures. This can be due to factors such as high demand, limited resources, and the prioritization of urgent cases.

The primary care system works well in our country. We can diagnose and manage a wide range of acute and chronic health conditions, as well as provide preventive care, health promotion, and wellness counseling. However, if a patient needs specialized care or exams, they wait a long time in the waiting list to be called, and this, depending on the disease we are talking about, can worsen the quality of life of the patient.

We also have the private health system in Brazil, that provides an alternative option for individuals and families seeking timely access to healthcare services, specialized care, and enhanced amenities beyond what is available through the public healthcare system. However, access to private healthcare services may be limited by factors such as affordability, geographic location, and the availability of health insurance coverage.

Another option in Brazil is private health insurance, with many individuals and families opting to purchase private health insurance plans to access private healthcare services. Health insurance companies offer a variety of plans with different coverage options, including individual plans, family plans, and employer-sponsored plans.

Overall, opinions about healthcare systems in Brazil, including SUS, are diverse and multifaceted, reflecting the complex realities of healthcare delivery, financing, and governance in the country. While I recognize the significant achievements and aspirations of SUS, there are also ongoing debates and efforts to address its shortcomings and improve the overall quality, accessibility, and sustainability of healthcare for all Brazilians. +

Fernanda Furtado Sparrenberger, MD General Practitioner, Postgraduate in Family Medicine fernanda.sparrenberger@yahoo.com