Brazil's unified health system: the first 30 years and prospects for the future
Brazil's unified health system: the first 30 years and prospects for the future
复制标题
DOI：
10.1016/s0140-6736(19)31243-7
复制
发表时间：
2019-07-27
期刊：
影响因子：
168.9
通讯作者：
Atun, Rifat
中科院分区：
文献类型：
--
作者：
Castro, Marcia C.;Massuda, Adriano;Atun, Rifat
1988年，《巴西宪法》将健康界定为一项普遍权利和国家责任。巴西通过1990年建立的统一卫生系统（Sistema Unico de Saude [SUS]）在实现全民健康覆盖方面取得了进展。巴西在实施保健方案和组织保健系统方面有成功也有挫折，因此，巴西几乎实现了全民享有保健服务。单一卫生系统的发展和扩张轨迹为如何在一个高度不平等、政府分配给医疗服务的资源相对较低的国家扩大全民健康覆盖提供了宝贵的经验教训与中等收入和高收入国家相比。收入国家。对单一保健系统建立以来30年的分析表明，创新不仅限于发展新的保健模式，而且突出了建立政治、法律的、组织和管理相关结构的重要性，明确规定了联邦和地方政府在保健服务的治理、规划、筹资和提供方面的作用。单一保健系统的扩大使巴西能够迅速满足人口不断变化的保健需求，在短短30年内大幅扩大了保健服务的覆盖面。然而，尽管取得了成功，但对未来情景的分析表明，迫切需要解决长期存在的地域不平等、资金不足和私营部门与公共部门合作欠佳等问题。2016年实施的财政政策带来了紧缩措施，加上巴西政府新的环境，教育和卫生政策，可能会扭转SUS来之不易的成就，并威胁其可持续性和履行其为所有人提供医疗保健的宪法任务的能力。
In 1988, the Brazilian Constitution defined health as a universal right and a state responsibility. Progress towards universal health coverage in Brazil has been achieved through a unified health system (Sistema Unico de Saude [SUS]), created in 1990. With successes and setbacks in the implementation of health programmes and the organisation of its health system, Brazil has achieved nearly universal access to health-care services for the population. The trajectory of the development and expansion of the SUS offers valuable lessons on how to scale universal health coverage in a highly unequal country with relatively low resources allocated to health-care services by the government compared with that in middle-income and high-income countries. Analysis of the past 30 years since the inception of the SUS shows that innovations extend beyond the development of new models of care and highlights the importance of establishing political, legal, organisational, and management-related structures, with clearly defined roles for both the federal and local governments in the governance, planning, financing, and provision of health-care services. The expansion of the SUS has allowed Brazil to rapidly address the changing health needs of the population, with dramatic upscaling of health service coverage in just three decades. However, despite its successes, analysis of future scenarios suggests the urgent need to address lingering geographical inequalities, insufficient funding, and suboptimal private sector-public sector collaboration. Fiscal policies implemented in 2016 ushered in austerity measures that, alongside the new environmental, educational, and health policies of the Brazilian government, could reverse the hard-earned achievements of the SUS and threaten its sustainability and ability to fulfil its constitutional mandate of providing health care for all.