The Brazilian health system at crossroads: progress, crisis and resilience
The Brazilian health system at crossroads: progress, crisis and resilience
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DOI：
10.1136/bmjgh-2018-000829
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发表时间：
2018-07-01
影响因子：
8.1
通讯作者：
Atun, Rifat
中科院分区：
文献类型：
--
作者：
Massuda, Adriano;Hone, Thomas;Atun, Rifat
统一卫生系统使巴西在实现全民健康覆盖方面取得了重大进展。然而，结构性弱点、经济和政治危机以及限制公共支出增长的紧缩政策正在威胁其可持续性和成果。本文分析了自2000年以来巴西卫生系统的进展，以及经济和政治危机以及随后的紧缩政策的当前和潜在影响。我们使用文献综述，政策分析和政府来源的二手数据在2000-2017年检查的变化，在政治和经济背景下，卫生筹资，卫生资源和医疗服务覆盖面在SUS。我们发现，尽管有一个有利的背景下，使扩大全民健康覆盖从2003年到2014年，结构性问题仍然存在，在SUS，包括组织和治理的差距，低公共资金和次优资源分配。因此，在获得保健服务和保健结果方面存在着巨大的区域差异，较贫穷地区和社会经济地位较低的人口群体处于最不利的地位。随着现任政府推出的紧缩措施，这些结构性问题和差距可能会恶化，并有可能扭转单一卫生系统在改善人口健康结果方面取得的成就。当前危机和政治危机的不利影响在巴西卫生系统中迅速显现，这突出表明必须加强卫生系统的复原力，以抵御外部冲击（如经济和政治危机）和内部冲击（如针对具体部门的紧缩政策和迅速老龄化导致疾病负担上升），保护在全民健康覆盖方面取得的来之不易的进展。
The Unified Health System (Sistema Unico de Saude (SUS)) has enabled substantial progress towards Universal Health Coverage (UHC) in Brazil. However, structural weakness, economic and political crises and austerity policies that have capped public expenditure growth are threatening its sustainability and outcomes. This paper analyses the Brazilian health system progress since 2000 and the current and potential effects of the coalescing economic and political crises and the subsequent austerity policies. We use literature review, policy analysis and secondary data from governmental sources in 2000-2017 to examine changes in political and economic context, health financing, health resources and healthcare service coverage in SUS. We find that, despite a favourable context, which enabled expansion of UHC from 2003 to 2014, structural problems persist in SUS, including gaps in organisation and governance, low public funding and suboptimal resource allocation. Consequently, large regional disparities exist in access to healthcare services and health outcomes, with poorer regions and lower socioeconomic population groups disadvantaged the most. These structural problems and disparities will likely worsen with the austerity measures introduced by the current government, and risk reversing the achievements of SUS in improving population health outcomes. The speed at which adverse effects of the current and political crises are manifested in the Brazilian health system underscores the importance of enhancing health system resilience to counteract external shocks (such as economic and political crises) and internal shocks (such as sector-specific austerity policies and rapid ageing leading to rise in disease burden) to protect hard-achieved progress towards UHC.