OECD Reviews of Health Systems: Brazil 2021

In the 30 years since the inception of the Unified Health System (Sistema Único de Saúde, or SUS), Brazil has reduced health inequalities, and improved coverage and access to health care. However, mobilising sufficient financing for the universal health coverage mandate of SUS has been a constant challenge, not helped by persistent inefficiencies in the use of resources in the Brazilian health system. Demographic and epidemiological changes, rising expectations from society, and the emerging needs of a post-COVID‑19 recovery period mean that continued adjustments and reforms are needed to ensure the sustainability of the health system. This review uses internationally recognised indicators and policy frameworks to examine the performance of Brazilian health system. The report points to key actions that Brazil should consider prioritising in the coming years to strengthen health system performance, especially improving efficiency and sustainability of financing, upgrading its health data infrastructure to leverage a digital transformation, and addressing major population risk factors such as overweight and harmful alcohol consumption. A companion publication with a review of primary health care in Brazil further examines the key role of primary health care to improve the performance of the Brazilian health system.

Published on December 14, 2021Also available in: Portuguese

In series:OECD Reviews of Health Systemsview more titles

TABLE OF CONTENTS

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Foreword	Read PDF
Acronyms and abbreviations	Read PDF
Executive summary	Read PDF
Assessment and recommendations for the health system in Brazil	Read PDF
Health care needs and the health care system in Brazil	Read PDF
Financial sustainability of health spending and efficiency	Read PDF
Health data infrastructure and information system in Brazil	Read PDF
The economics of overweight in Brazil	Read PDF
The economics of alcohol consumption in Brazil	Read PDF

HIGHLIGHTS

Brazil devoted less of its public budget to health (10.5%) than most OECD countries in 2019, well below the average of 15.3%.
Health spending in Brazil is expected to increase to 12.6% of GDP by 2040 (up from 9.6% in 2019) and could be made more efficient in areas like primary healthcare, hospital care, pharmaceuticals, long-term care and governance.
By 2050, in Brazil 21.9% of the population is expected to be 65 years or older, up from 8.9% in 2017. Brazil needs to anticipate the future long-term care needs of an ageing population.
Brazil should better use health data to follow the patients throughout episodes of care, to regularly monitor healthcare quality and performance.
In Brazil, around 90% of pharmaceutical spending is financed by out-of-pocket payments. Gaps in pharmaceutical coverage remain an important issue that affects poor and disadvantaged people disproportionally.
There is an urgent need for better prevention and an improved public health strategy, notably to address the increase in overweight and harmful alcohol consumption in recent years:
- Heavy episodic drinking among adults has almost tripled in six years, from 5.9% in 2013 to 17.1% in 2019
- Overweight increased by 12.5 % between 2006 and 2016, the fourth largest growth rates behind only Costa Rica, Japan and Korea

Health expenditure from public sources as a share of total government expenditure, 2019 (or latest year)

Health expenditure from public sources_Brazil

Note: Government expenditure includes expenditure by government schemes and social health insurance.
Source: OECD (2021), OECD Reviews of Health Systems: Brazil 2021, OECD Reviews of Health Systems.

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OECD Reviews of Health Systems: Brazil 2021

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