TY - JOUR

T1 - The National Health Services of Brazil and Northern Europe

T2 - Universality, Equity, and Integrality-Time Has Come for the Latter

AU - Gurgel Jr., Garibaldi D.

AU - Carvalho de Sousa, Islâandia M.

AU - de Araujo Oliveira, Sydia Rosana

AU - da Silva Santos, Francisco de Assis

AU - Diderichsen, Finn

PY - 2017/10/1

Y1 - 2017/10/1

N2 - In 1990 the national health services in the United Kingdom and Sweden started to split up in internal markets with purchasers and providers. It was also the year when Brazil started to implement a national health service (SUS) inspired by the British national health service that aimed at principles of universality, equity, and integrality. While the reform in Brazil aimed at improving equity and effectiveness, reforms in Europe aimed at improving efficiency in order to contain costs. The European reforms increased supply and utilization but never provided the large increase in efficiency that was hoped for, and inequities have increased. The health sector reform in Brazil, on the other hand, contributed to great improvements in population health but never succeeded in changing the fact that more than half of health care spending was private. Demographic and epidemiological changes, with more elderly people having chronic disorders and very unequal comorbidities, bring the issue of integrality in the forefront in all 3 countries, and neither the public purchaser provider markets nor the 2-tier system in Brazil delivers on that front. It will demand political leadership and strategic planning with population responsibility to deal with such challenges.

AB - In 1990 the national health services in the United Kingdom and Sweden started to split up in internal markets with purchasers and providers. It was also the year when Brazil started to implement a national health service (SUS) inspired by the British national health service that aimed at principles of universality, equity, and integrality. While the reform in Brazil aimed at improving equity and effectiveness, reforms in Europe aimed at improving efficiency in order to contain costs. The European reforms increased supply and utilization but never provided the large increase in efficiency that was hoped for, and inequities have increased. The health sector reform in Brazil, on the other hand, contributed to great improvements in population health but never succeeded in changing the fact that more than half of health care spending was private. Demographic and epidemiological changes, with more elderly people having chronic disorders and very unequal comorbidities, bring the issue of integrality in the forefront in all 3 countries, and neither the public purchaser provider markets nor the 2-tier system in Brazil delivers on that front. It will demand political leadership and strategic planning with population responsibility to deal with such challenges.

KW - health sector reform

KW - equity

KW - efficiency

KW - integrality

KW - Brazil

KW - Sweden

KW - United Kingdom

U2 - 10.1177/0020731417732543

DO - 10.1177/0020731417732543

M3 - Journal article

C2 - 28958178

VL - 47

SP - 690

EP - 702

JO - International Journal of Health Services

JF - International Journal of Health Services

SN - 0020-7314

IS - 4

ER -