Have the SUS Reforms Transformed the Brazilian Health System?

Abstract

Discusses the extent to which reforms have transformed the health system, focusing on the expansion and reorganization of service delivery, financing of health services, and governance and accountability arrangements of the Brazilian Unified Health System (Sistema Único de Saúde, SUS). The reforms envisaged a fundamental transformation, with universality, equity, integration, decentralization, and participation as key principles. Significant progress has been made, in that the capacity to deliver services has expanded, regional disparities in the availability of services have been reduced, primary health care has been strengthened, most of the responsibilities for delivering services have been decentralized to municipalities, government health expenditures have increased, and various institutional mechanisms and innovations have been introduced to enhance coordination, participation, and efficiency. The SUS reforms also triggered several initiatives aimed at increasing and stabilizing public financing for health. Important challenges for the future include intergovernmental finance and coordination and the evaluation and consolidation of models for contracting, integrating, and delivering health services.