(Press-News.org) Two decades after Brazil's constitution recognized health as a citizen's right and a duty of the state, the country has vastly expanded health care coverage, improved the population's health, and reduced many health inequalities, but universal and equitable coverage remains elusive, experts from four major Brazilian universities and New York University have concluded.
According to their analysis—one of six articles published in the medical journal The Lancet as a special series on health in Brazil—while federal expenditures have nearly quadrupled over the past 10 years, the health sectors' share in the federal budget has not grown, resulting in constraints on health care financing, infrastructure, and human resources.
The paper's co-authors were: Jairnilson Paim of the Federal University of Bahia; Claudia Travassos of Center for Communication, Scientific Information and Technology at the Oswaldo Cuz Foundation; Celia Almeida of the National School of Public Health, Oswaldo Cruz Foundation; Ligia Bahia of the Federal University of Rio de Janeiro; and James Macinko, an associate professor at New York University's Steinhardt School of Culture, Education, and Human Development.
After more than 20 years of a military dictatorship, Brazil created its present constitution in 1988, which included health as a right of citizenship. Health care reform in Brazil, then, occurred under unique circumstances--simultaneously with the process of democratization and spear-headed by health professionals along with civil society movements and organizations.
To meet this constitutional guarantee, the country established the Unified Health System, or Sistema Único de Saúde (SUS), which was based on the principles of universality, equity, integrality, and social participation. The SUS, which serves more than 192 million citizens, is supplemented by private insurers, which cover about 25 percent of Brazilians.
Overall, the Brazilian health system is made up of a complex network of complementary and competitive service providers and purchasers, forming a public–private mix that is financed mainly by private funds.
During the past two decades, the researchers noted, the SUS has undergone significant changes. Among these were granting municipalities greater responsibility for health service management, along with the flexibility and means which to bring about social participation in health policy making and accountability.
In the Lancet study, the researchers found vastly increased access to health care for a substantial proportion of the Brazilian population. In 2009 alone, the SUS financed about 12 million hospitalizations, delivered nearly 100 million ambulatory care procedures per month, and reached universal coverage of vaccination and prenatal care. It also expanded the supply of related human resources and technology, including enhanced production to meet most of the country's pharmaceutical needs.
But the researchers also observed that "the SUS is a health system under continual development that is still struggling to enable universal and equitable coverage."
"As the private sector's market share increases, interaction between the public and private sectors are creating contradictions and unfair competition, leading to conflicting ideologies and goals—notably, universal access vs. market segmentation," they wrote. "All of this has a negative effect on the equity of health-care access and outcomes."
Further complicating the nation's goal of universal coverage are constraints on federal funding. While federal expenditures have increased nearly four times over the past 10 years, they added, the health sectors' share in the federal budget has not grown, producing constraints on financing, infrastructure, and human resources.
"The development of the Brazilian health system reflects the uneven process of social, economic, and political development within the country," the researchers wrote. "Ultimately, to overcome the challenges that Brazil's health system faces, a revised financial structure and a thorough reassessment of public-private relations will be needed. Therefore, the greatest challenge facing the SUS is political. Such issues as financing, composition of the public–private mix, and the persistent inequities cannot be solved in the technical sphere only."
### END
Brazil's health care system vastly expands coverage, but universality, equity remain elusive
2011-05-11
ELSE PRESS RELEASES FROM THIS DATE:
High-tech approach uses lights, action and camera to scrutinize fresh produce
2011-05-11
This release is available in Spanish.
High-tech tactics to carefully examine apples and other fresh produce items as they travel along packinghouse conveyor belts will help ensure the quality and safety of these good-for-you foods.
U.S. Department of Agriculture (USDA) scientists in Beltsville, Md., have developed and patented an experimental, cutting-edge optical scanning system that would use two different kinds of lighting, a sophisticated camera and other pieces of equipment to scrutinize produce-section favorites while they are still at the packinghouse.
The ...
Training to promote health
2011-05-11
This release is available in German.
Marianne has constant pain in her right knee at the moment – she hurt it when she took a tumble skiing in the Swiss Alps. Everything happened so quickly: The searing pain, the helicopter ride to hospital, the operation the following day, and then a week later the return home with crutches to rest in a reclining chair. Her aim now is to mobilize the operated knee and regain full mobility of the joint – something she'll achieve by following a targeted machine-based training plan drawn up by a physiotherapist.
In order to be able ...
Depression associated with poor medication adherence in patients with chronic illnesses
2011-05-11
People who are depressed are less likely to adhere to medications for their chronic health problems than patients who are not depressed, putting them at increased risk of poor health, according to a new RAND Corporation study.
Researchers found that depressed patients across a wide array of chronic illnesses such as diabetes and heart disease had 76 percent greater odds of being non-adherent with their medications compared to patients who were not depressed. The findings were published online by the Journal of General Internal Medicine.
The study is the largest systematic ...
Study: Lowering cost doesn't increase hearing aid purchases
2011-05-11
DETROIT – Lowering the cost of hearing aids isn't enough to motivate adults with mild hearing loss to purchase a device at a younger age or before their hearing worsens, according to researchers at Henry Ford Hospital.
A new study shows that simply lowering the cost of hearing aids – even by as much as 40% – does not improve hearing aid purchase for patients with partial insurance coverage or those who need to cover the entire cost out of pocket.
Only patients with full insurance coverage for hearing aids get them at a younger age and with significantly less hearing ...
Zebrafish models identify high-risk genetic features in leukemia patients
2011-05-11
SALT LAKE CITY—Leukemia is the most common childhood cancer; it also occurs in adults. Now researchers working with zebrafish at Huntsman Cancer Institute (HCI) at the University of Utah have identified previously undiscovered high-risk genetic features in T-cell acute lymphocytic leukemia (T-ALL), according to an article published online May 9, 2011, in the cancer research journal Oncogene. When compared to samples from human patients with T-ALL, these genetic characteristics allowed scientists to predict which patients may have more aggressive forms of the disease that ...
2 new studies describe likely beneficiaries of health care reform in California
2011-05-11
According to two new policy briefs from the UCLA Center for Health Policy Research, the majority of state residents likely to be eligible for federally mandated health insurance coverage initiatives in California in 2014 are also those who may be least likely to excessively use costly health services: men, singles and those of working age.
As a result of last year's passage of the federal Patient Protection and Affordable Care Act (ACA), up to 4.57 million previously uninsured or underinsured Californians may be eligible for coverage, either through an expansion of ...
Less than half of patients with MS continually adhere to drug therapies for treatment: Study
2011-05-11
TORONTO, Ont., May 11, 2011 — Disease-modifying drugs (DMDs) are injected medications used to slow the progression of multiple sclerosis (MS), and have been shown to reduce the frequency and severity of relapses. But according to a new study led by St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES), adherence to all DMDs is low, with less than half of patients, or 44 per cent, continually adherent after two years.
"There are a number of reasons why adherence to therapies of proven value might be low," says Dr. Paul O'Connor, director of the ...
Harnessing the energy of the Sun: New technique improves artificial photosynthesis
2011-05-11
This discovery will make it possible to improve photoelectrochemical cells. In the same way that plants use photosynthesis to transform sunlight into energy, these cells use sunlight to drive chemical reactions that ultimately produce hydrogen from water. The process involves using a light-sensitive semi-conducting material such as cuprous oxide to provide the current needed to fuel the reaction. Although it is not expensive, the oxide is unstable if exposed to light in water. Research by
Adriana Paracchino and Elijah Thimsen, published May 8, 2011 in the journal Nature ...
Foot and mouth disease may spread through shedding skin cells
2011-05-11
LIVERMORE, Calif. --Skin cells shed from livestock infected with foot and mouth disease could very well spread the disease.
In a new paper appearing in the Proceedings of the Royal Society B, Lawrence Livermore National Laboratory scientist Michael Dillon proposed that virus-infected skin cells could be a source of infectious foot and mouth disease virus aerosols. His proposal is based on the facts that foot and mouth disease virus is found in skin and that airborne skin cells are known to transmit other diseases.
The proposal could lead to new methods for surveillance ...
Doppler effect found even at molecular level – 169 years after its discovery
2011-05-11
CORVALLIS, Ore. – Whether they know it or not, anyone who's ever gotten a speeding ticket after zooming by a radar gun has experienced the Doppler effect – a measurable shift in the frequency of radiation based on the motion of an object, which in this case is your car doing 45 miles an hour in a 30-mph zone.
But for the first time, scientists have experimentally shown a different version of the Doppler effect at a much, much smaller level – the rotation of an individual molecule. Prior to this such an effect had been theorized, but it took a complex experiment with a ...