By Carl Bob Willis.
The Brazilian constitution enshrines healthcare as a citizen’s right and the duty of the state. Since the constitution’s adoption in 1988, Brazil has made considerable progress in improving health indicators, but much still needs to be done to tackle regional disparities in health care performance, expand coverage and increase the efficiency of healthcare spending.
Brazil has made significant advances in improving basic health. According to the national statistical institute (IBGE), the infant mortality rate (the deaths of children less than one year old) fell from 29.4 per one thousand infants born in 2001 to 17.3 in 2010, which represents a reduction of almost 50% over the last decade. Life expectancy at birth improved to 73 years in 2010 from 70 years in 2000 (see chart below). Before 1988, only 30 million Brazilians had access to health services, according to the Ministry of Health. The coverage expanded to 140 million, roughly three-quarters of the population, by 2008.
Despite these advances, Brazil still needs to bridge regional imbalances in key health indicators and increase healthcare coverage. The census data from 2010 suggests that while the northeast region recorded a major decrease in infant mortality, the rate remains above the national average at 18.5 deaths per 1,000, the highest infant mortality in the country.
In terms of coverage, there were only 2.4 hospital beds per 1,000 Brazilians in 2010, which is far below the eurozone average of 5.8 hospital beds per 1,000 inhabitants and below regional peers like Argentina (with 4.5 hospital beds per 1,000). Also, there were only 1.8 doctors per 1,000 Brazilians in 2008 (the latest year for which data are available), which is below the 2009 average of 2.0 doctors per 1,000 in Mexico and 2.4 doctors per 1,000 in the US.
Infant mortality has fallen, while life expectancy has risen
Source: Haver, Timetric
Meanwhile, Brazil could extract greater value from its healthcare spending. According to World Bank data, healthcare spending in Brazil as a percentage of GDP, at 9% in 2010, is higher than in many other Latin American countries (see Chart below). And, over the past decade, the country’s healthcare spending has compared favorably with others in the region. Nevertheless, its key health indicators pale in comparison. Brazil’s infant mortality rate – at 17.3 in 2010 – is higher than Argentina’s (12.3), Chile’s (7.7), Mexico’s (14.3), Peru’s (14.9) and Venezuela’s (15.7). Also, Brazil’s life expectancy at birth in 2010 was 73.1 years, which is below Argentina’s (75.6), Chile’s (78.9), Mexico’s (76.7), Peru’s (73.8) and Venezuela’s (74.1).
The backbone of Brazil’s health system, the Unified Health System or Sistema Único de Saúde (SUS), which provides primary, secondary and tertiary care through a complex network of public and private service providers, does not get enough bang for its buck, owing to conflicts over resources between primary health care programs and hospitals. The system’s potential is also stymied by widespread abuse, through overbilling and cheating, which results in the SUS overpaying for procedures.
Furthermore, Brazil faces the challenge of an aging population. According to the census bureau, the percentage of the population aged 65 or older will rise from 7% in 2010 to 13% in 2030. The median age in Brazil is expected to reach 38 in 2030, up from 29 in 2010. A World Bank report predicts the elderly population will more than triple over the next four decades, from less than 20 million in 2010 to approximately 65 million in 2050. This demographic shift will put additional pressures on publicly financed health care.
Brazil also needs to tackle an increase in lifestyle diseases related to obesity, such as diabetes. Rates of self-reported diabetes have risen from 3.3% in 1998 to 5.3% in 2008. A shortage of healthcare professionals in the public sector, due to their migration to the private sector, is also a key challenge.
While an increase in healthcare spending likely would improve the system, it needs to be coupled with reform to reduce resource waste. Also, the government would do well to focus its efforts on those regions most dependent on public healthcare, while making room for private healthcare service providers to reach those Brazilians who can afford to pay.