Restructuring Brazil’s Public Healthcare System

Brazil’s free public healthcare system, the Sistema Único de Saúde (SUS), has served the country well for over 30 years. It propelled investments in historically underserved regions and municipalities throughout the country, and SUS programs such as the Programa Saúde da Família, or Family Health Program, have helped to narrow gaps in healthcare access. While the achievements of SUS cannot be understated, its 20th century approach is ill-suited to address the distinctively 21st century problems facing Brazil, including a changing disease burden and an aging population. With these pressing challenges in mind, the Council for Social Responsibility (CONSOCIAL), part of the Federation of Industries of the State of São Paulo, has partnered with Aceso Global to redesign SUS for the 21st century.

This task involves much more than merely updating the existing SUS structure – it entails completely redesigning the public financing, payment and delivery of healthcare in Brazil to reflect evidence-based global trends and best practices. The presentation draws on the accomplishments of SUS to date, as well as innovations from the Brazilian private healthcare sector, that together form the foundation of the proposed restructuring. Specifically, the approach proposes a Network Model for SUS that:

  • develops population health management through an integrated network delivery model;

  • entails new levels of collaboration across municipalities in the delivery of services;

  • places quality of care and accountability at the center of the system;

  • leverages IT and digital health platforms to facilitate health system changes;

  • employs new financing and payment arrangements; and

  • aligns the public and private sectors.

While ambitious, major shifts will be required to improve the health and prosperity of millions of Brazilians who rely on SUS.

Aceso Global worked with CONSOCIAL and other in-country partners, including the Brazil-based Instituto Performa, in an iterative co-design process to test and define the proposed restructuring. It is being discussed and initial pilots are under design to refine the concepts and test new approaches.