Medicine and Healthcare in Brazil - Research Paper Example

? Medicine and health care in Brazil Your al affiliation This paper explores several studies regarding health care system and people access to it in Brazil during 1996 to 2011. The resources consulted include journal articles, books, and online articles which use scientific methods in order to evaluate the level of inequalities on the basis of social status and class when it comes to accessing health care services in Brazil. The study identifies that despite the presence of a universal health care system and division of responsibilities among, federal, state government, and municipalities, disparities in getting access to healthcare opportunities are evident and favors rich and privilege class in nearly all the areas. The study also suggests the allocation of medical staff and finances on the basis of vulnerability and need in order to implement health care as a basic right in Brazil. Medicine and health care in Brazil This paper studies the medicine and health care system in Brazil. I argue that Brazil has achieved major progress in health care system through continuous reforms. To prove my hypothesis, I will analyze income and class factors that are attributed to the access to health care system in Brazil. I’ll examine whether there is a difference in the chances to access healthcare services after the division of health care system in private and public sector. The paper analyses different studies from 2000-2011 in order to evaluate the existence of social inequality when it comes to accessing the healthcare services in Brazil. Health care system in Brazil initiated in 1923 with the establishment of social security system for urban workers in private sector by Eloi Chaves Law. Universality and equality of health services was not acknowledged before 1988, therefore the system was not as just and equal for every citizen (Cordeiro as cited in Elias& Amelia, 2002, p.4). Furthermore, Eliasand Amelia (2002) states that, “health care access is no longer organized according to a social security model, be it publically or privately based [since] 1988; health has been a right granted to all and an obligation of the state” (p.5). Brazil acquired a universal health care policy in 1988; the system originated a network of public providers in order to deliver complete range of health services from typical diseases to sex change operation, free of charge. Public network evolved into the Family Health Program (Programa Saude da Familia PSF). PSF worked by assigning a team of a doctor, nurse, nurse’s assistant, and other health workers to families in a particular region for providing free health care services(Cataife and Charles,2011,p.2). Health care system is divided in public and private sectors in Brazil. Sistema Unico de Saude (SUS) is the public system which is created and defined in the Federal Constitution of 1988 in addition to the 1990 Organic Health Law. The system is working on the fundamental principles of universality, decentralization, and integrality. Universality refers to the idea that health care is a universal right and state is responsible for providing free health care facilities to its citizens. Integrality refers to the division of public health assistance into primary, secondary, and tertiary levels of care. Decentralization further divides the system by entitling municipalities as responsible for management and organization of health services (Cataife and Charles, 2011, p.2).SSAM is being regulated by government in Brazil for ensuring consumer rights and to avoid expensive procedure and health care plans for SUS services. The segmentation gives rise to social inequality that cannot be easily confronted (Elias& Amelia, 2002.p.5). Under SUS, health care services are universal, comprehensive, and free of charge for every citizen. Private sector availability is guaranteed against out-of-pocket payments or by association with a particular insurance plan (Noronnha & Monica, 2002, p.1). “The great expansion of the private sector in Brazil occurred between 1987 and 1994 when the level of coverage increased by 73.4 % and the population with private coverage (24.4 million individuals in 1987) reached 42.3 millions in 1994 (PNAD 1998 as cited in Andrade, 2002, p. 472).The expansion of this sector corresponded with the establishment of SUS that is characterized to the ‘tributary incentives’ from federal government in addition to the poorer quality of the public health care services. According to the level of coverage and income data, health care services are not distributed equally throughout Brazil in different social groups (Andrade, 2002, p. 472). Brazil is the 5th largest country with respect to its area and population. SUS is amongst the world’s largest public health care systems. The ambulatory system includes 56,640 units that assists 350 million cases every year,moreover,6,439 hospitals and 487,058 hospital beds are included in the SUS network.SUS handled 250 million consultations,200 million laboratory tests, and 70 million procedures of higher complexity(Rehem de Souza, as cited in Cataife and Charles,2011,p.2). The SUS network includes public, on-profit, and for-profit providers, however, services are compensated by federal, state, and municipal governments (Uga and Santos, 2007, p.1020). Private health care system is sisterna suplermentar de saude (SSS) it includes the system which are not associated with SUS. In private system, the patients pay their medical bills. Individual and group health insurance plans assist in enduring the costs; however, it has a low coverage rate. About 20% of total Brazilian population benefit from SSS, it amounts to nearly half of Brazil’s medical expenditures (Cataife and Charles, 2011, p.3). Brazil is a diverse region with a geographic variation when it comes to health and access to health care services. Referring to Pan American Health Organization (2008), Cataife and Charles (2011) state that “the infant mortality rate of 35.5 per 1,000 in the Northeast…country is most developed region the Southeast. Endemic and transmittable diseases are notoriously persistent in the less developed North, Northeast and Center-West regions” ( p.3).Furthermore, over 50 percent of all registered deaths are caused due to uncertain reasons. There is a great potential that these uncertain conditions are reactions to the lacking health care services (Lobato, 2000, pp.104-105). According to previous research studies, Brazil’s universal health care system has positive impacts on the health and access to health care services(Macinko et al.,2006 and 2007;Rasela et al.,2010;Morsch et al.,2001;Goldbaum et al.,2005 as cited in Cataife and Charles, 2011, p.17). However, the segmentation of health care system into two subsystems led to division of finances where SUS is exclusively funded by public resources and is responsible for both high risk and population and more expensive treatments and procedures. Decentralization of health services adjusted the local health system with the needs of local population in addition to increasing public control over health policies. In this setup, the finances are based on historical budgets; therefore, there is considerable competition for finances among local government and state. As a result, impartial distribution of resources was halted and inequalities in health care access reproduced (Elias & Amelia, 2003, p.47). Buss and Paulo (1996) analyzed overall health care services and its efficient utilization in Brazil and identified that it varies with incomes irrespective of the geographical area. For the families with more than US$25 per week, number of doctor visits was 83 per 1000 people, on the other hand, it is 138 per 1000 people with the families with twice the monthly minimum income ($200 or more).Irrespective of the limited numbers of studies that measure the equity of SUS provided services, similar level of inequality is identified in the utilization of SUS services. SUS also preferred people with higher income in a way or the other (p.392). Based on the PNSN (a national survey on health and nutrition) (1989), Celia et al. (2000, pp.129-59) examined the social inequality in the health care system when it comes to access. They analyzed health care service utilization ratio for each income quintile. The rates considered after standardizing them by age and sex and by collecting separate samples from sick and healthy individuals. The study found that the healthcare services utilization is substantially disproportionate among socioeconomic strata and there is strong inclination towards supporting higher income levels. Nearly 45% people with limited activity level used healthcare services in case of illness from first quintile. The rate increased to 69.22% in case of higher income group. On the other hand, healthy individual sample revealed 50% higher utilization as compared to lowest-income strata in the fifth quintile. Furthermore, the data suggested a higher level of inequality in the delivery of health care services across the country despite regulatory measures for increasing effectiveness and reducing inequalities. Travassos et al.(2000) also confirmed the presence of social inequality in the distribution of healthcare services in Brazil which supports privileged class in the country. The prospects of utilizing healthcare services is 37 percent lower in Brazilian Northeast, and 35 percent lower in Southeast when compared to the Brazilians in the third tercile. Healthcare service utilization chances are higher(66 percent higher in Northeast and 73 percent in Southeast) among people opting health insurance plans as compared to those who don’t. Study analysis suggests a small reduction in inequalities when it comes to accessing healthcare services between 1989 and 1996-1997 while indicating that Brazilian healthcare system continued to be unequal(pp.133-145). Viacava (2001) research study examined social inequalities in accessing health care services in Brazil by gender while utilizing the data from the PNAND(the National Household Sample Survey) 1998.It is observed that people holding higher education degrees, employers, whites, and formal sector employees are more likely to seek opportunities for both preventive and curative healthcare services. This scenario indicates substantial amount of inequality in the utilization of medical services that favor a certain class(as cited in Cataife and Charles, 2011,p.6).Furthermore, Andrade (2002,p. 475) observes that the most important aspect of health services in Brazil is the equity of access to such services. It has always been the promotion of equitable health care services in Brazil as they project unified healthcare system. However, empirical analysis identified general healthcare services disparity that favors privileged class or higher income groups. Aiming at testing the hypothesis of horizontal equity in approaching health care services in Brazil, Noronnha and Monica(2002)consider outpatient and inpatient cases individually. Main objective of the study is to identify whether people in Brazil have equal health care opportunities irrespective of their socioeconomic status. They used hurdle negative binomial model(hurdle negbin) for evaluating health care services in two stages. Two different samples and comprehensive database PNAD/98-Pesquisa Nacional de Amostra Domiciliar(The Brazilian National Household Sample Survey) are used to estimating every type of health care. Analysis revealed that social inequality exists in favor of  privileged class when it comes to accessing health care services in  Brazil. The situation remains the same even if morbidity, health insurance coverage, and occupational  attributes are controlled. Negative binomial hurdle model is relevant because it allows to judge individual behavior when it comes to estimate inequality or the medical service provider's behavior while deciding on the level of treatment a patient should receive (pp.2-35). Noronnha and Monica (2002) took the empirical studies a step further which suggested the presence of disparities in access of health care services in Brazil. Taking the discussion further, the study evaluated whether the existing disparity is associated with contact decision or frequency decision. The results for ambulatory services confirmed that there is inequality in the access of health care services in Brazil which is pro-rich. They also identified a barrier among low-income groups even before any contact. Full time workers and precarious labor market workers are less likely to visit doctor both in probability and frequency which reflects the higher opportunity cost of demanding health care service. The research, however, identifies the limitations of the model and suggests further study in order to evaluate the inequality  in Brazilian health care system(pp.6-35).The research  also ignores other crucial factors of not visiting the doctor or seeking medical help, such as, personal issues, fears, and self-assessment. According to Lobato (2000): Social inequality this remains the main health and social policy issue in Brail. Although the ninth largest economy in the world, the country’s social indicators are still cause for concern. According to United Nations Report on Human Development (IPEA 1996), in 1995 Brazil ranked one of the worst of 55 countries in terms of social inequality. The average income among the richest 10% was about 30 times the average income among the poorest 40%.In most countries this ratio is usually 10 times at most. (p.105) Brazilian health care is a diverse system and its division in sub-systems can be responsible for the existence of social inequality when it comes to accessing the health care services that favors rich or privileged class. Furthermore, epidemiological profile of Brazilian population has changed over a period of time. It has transformed into far more complex that incorporate disease and persistence of disease which is associated with social status and inequality (Lobato, 2000, p.104). In their empirical research, Cataife and Charles(2011,p.15) analyzed if income-based inequalities in health care service availability is systematically different in states with extensive coverage areas of Family Health Program(PSF).Government implemented PSF in 1994 in order to enhance primary health care access and reduce inequality. By assessing nationally representative sample of 46,000 Brazilians from 2003, they examine whether medical services inequalities exist after the establishment of a public network. Through evidence, they identified a positive association between income and doctor visits, private doctor visits, and private medical expenses. A pro-rich inequality was also identified in pubic doctor visits which disappeared after considering constant effects for changes in access and quality of medical services in different areas. The estimation of income elasticity of private medical expenses and findings reveled that despite the development of free public health care system, private care has consistently been a necessity. The study suggests that public health care system is not effectively covering the most deserving segments of Brazilian population (Cataife and Charles, 2011, p.1-15). In their thorough study, Cataife and Charles (2011) analyzed the issue of health care system disparities and contribute on many levels. While observing the inherent cost ineffectively of health care system and   highlighting the pro-rich disparity, they also point out some improvement in the health care system due to appointment of health workers in densely-populated areas. At the same time, the study puts forth some valuable suggestions, which appear to be quite practical and result-oriented, for instance, assigning smaller area or targeting only vulnerable group of people rather than all households by each PSF team; educate people about the objectives of PS in order to increase participation; associate SUS network in remote areas with private doctors. The study also addresses government in a compelling way by identifying that universal coverage through paying medical services does not translate into universal care. There are other factors than medical bills that prevent poor from getting appropriate medical facilities, such as, transportation cost (pp.17-18). Health reforms and care system analysis reveal that in order to achieve real inequality and universality of the system, it is crucial for government to recognize health as a universal right in practical terms. State’s role must be differentiated from payer for the health services. After having examined the evidence from Brazil, this study showed that there has been a substantial improvement in healthcare services and its delivery to the population. However, despite being a universal healthcare system in Brazil, the paper proves through evidence that there is a strong correlation between social status or class and a Brazilian’s ability to access healthcare services. Works Consulted Andrade,M.V.,(2002).Globalization and health in Brazil. NORD-SUD aktuell.[pdf document] Retrieved from: http://www.gigahamburg.de/openaccess/nordsuedaktuell/2002_3/giga_nsa_2002_3_andrade.pdf Buss,P. & Paulo,G.(1996).Health care systems in transition: Brazil Part 1:An outline of Brazil’s health care system reforms. Journal of Public Health Medicine,18(3),189-295. Cataife,G.,& Charles,C(2011).Is universal health care in Brazil really universal? Retrieved from: Social Science Research Network(SSRN).(Working paper series). Celia,A. Travassos,C.,Porto,S., & Labra, M.E.(2000). Health sector Reform in Brazil: a case study of inequity. International Journal of Health Services,30(1),129-62. Elias,P.E.M., & Amelia,C.(2002)Health reforms in Brazil: Lessons to consider. American Journal of Public Health,93(1),44-48. Noronha, K.V.M.S., & Monica, V.A..,(2002).Social inequalities in the access to health care services in Brazil. Retrieved from:ideas.repec.org.(td172). Travassos, C., Francisco,V. Cristiano,F., and Celia,M.A.(2000). Desigualdades geograficas e sociais na utilizacao de servicos de saude no Brasil. Rio de Janeiro: Ciencia e Saude Coletiva, 5 (1),133-149. Lobato,L. (2002).Recognising the health care system in Brazil..In Fleury,S.Susana,B., & Enis,B.(Ed.).Reshaping healthcare in Latin America: A comparative analysis of health care reform in Argentina, Brazil, and Mexico.(103-130).Canada: International Development Research Centre. Uga,M.& Santos,I.(2007).An analysis of equity in Brazilian health system financing. Health Affairs(Milliwood project),26(4),1017-28. Read More