‘Flawed but fair’: more than the U.S. can say?

“Flawed but fair” is the way the April 2008 Bulletin of the World Health Organization described the Sistema Unico de Saude, Brazil’s national health system.

Brazilian sentiment about Sistema Unico de Saude appears to echo that assessment – that the system isn’t perfect, but it does a decent job of providing medical services to millions of Brazilians who otherwise wouldn’t have access to health care.

In fact, access to health care is seen as a human right in Brazil and was legally established as such in the Brazilian Constitution of 1988.

The system itself was established in 1990, and has gradually grown to provide medical services to roughly 70 percent of Brazil’s population, according to the WHO.

Unlike the Canadian single-payer system, in which government funding pays for mainly privately-run health care, Sistema Unico de Saude is a system in which the government pays for government-run medical services, much like Great Britain’s National Health Service. The system provides health care services free-of-charge to any Brazilian citizen, not just those living in poverty.

In addition to Sistema Unico de Saude, there is a large private health care sector in Brazil that provides both insurance and medical services.

Among Brazilians who can afford private health care services, some utilize these private services exclusively, while others continue to use public services to varying degrees.

According to the Centro Brasileiro de Estudos de Saude, or the Brazilian Center for Health Studies, public expenditures comprise only 45 percent of annual total health care spending in Brazil, with private expenditures making up the other 55 percent. This figure is comparable to that of the United States, in which expenditures of public funds account for about 46 percent of total annual health care spending, according to the Kaiser Family Foundation.

Sistema Unico de Saude operates relatively efficiently, spending an estimated $158 per Brazilian per year, according to the WHO. In fact, many experts argue that the Brazilian government spends too little on health care.

Overall spending on health care in Brazil, including private-sector expenditures, is about $765 per capita and represents 7.5 percent of Brazil’s GDP, according to the WHO. In comparison, expenditure on health care in the United States is approximately $7,421 per capita, representing 16.2 percent of the United States’ GDP, according to the Kaiser Family Foundation.

Though Brazilian health statistics are not as good as those of the U.S. (for example, the infant mortality rate in Brazil per 1,000 births is 22.58, while in the U.S. it is 6.26, according to the CIA World Factbook), it still seems that Brazilians get much more bang for their health care buck than we do.

To be sure, there are several aspects of Sistema Unico de Saude that the United States would do well to imitate in its current health care overhaul, such as an emphasis on primary and preventive care.

At the very least, some of the successes that Sistema Unico de Saude has experienced, such as offering free vaccinations and excellent HIV and AIDS treatment and prevention, serve as examples of progress we’ve yet to make in our own health care system and help debunk the myth that the United States’ health care system is the best in the world.

Earlier this semester, for example, multiple family members in the U.S. expressed their concern about me being able to acquire Tamiflu in Brazil should I contract the H1N1 flu, as I have asthma.

Yet, while I heard stories of people in the United States not purchasing Tamiflu because of its price, here in Brazil, not only is Tamiflu available but it is given out free to anyone who has a confirmed case of H1N1.

Thus, while the United States’ health care system performs quite well in many different ways, it still has a good deal to learn from other systems. It could certainly take some pointers about equality of access from Brazil’s system.