Healthcare the Jan/Feb 2019 issue

Single Payer in South America

A look into Brazil’s healthcare system offers insights for brokers across the globe.
By Gustavo Quintão

Brazil is known internationally as having the largest state-funded health system in the world. Its system is seen as a touchstone of free, universally accessed healthcare.

Brazil’s 1988 Constitution declared: “Health is a right for all and the government’s duty to provide.” Building upon this ethos, Brazil created the Sistema Único de Saúde (SUS), a single-payer health system exclusively funded through tax collection at federal, state and municipal levels. Governed by the principles of providing a national, fair and full range of healthcare, the SUS supports more than 200 million Brazilians, giving them free access to public health services, offering a wide range of medical treatment and assistance, depending upon their needs.

But does the Brazilian healthcare system really guarantee quality medical services to all who need it? Sadly, no. In theory, the Brazilian model is very efficient; in reality however, the country runs into the same hurdles as its neighbors: hospitals, clinics and laboratories with failing infrastructures, a scarce number of professionals meeting the needs of many, long wait times and underfunding. And Brazil’s difficulties are made more intractable because of its vast territory and massive population.

Working in parallel to the public system is privately funded healthcare, known as Saúde Suplementar—supplementary health. It is used by a quarter of the country’s population, about 50 million people, who also can still use SUS services. Saúde Suplementar is highly thought of in Brazil; it has a better infrastructure than SUS, providing a higher-quality service with shorter wait times. But it’s not a panacea—the private system has its own problems to solve.

On one hand, employers, who fund 80% of private healthcare, are facing difficulties maintaining healthcare as a benefit due to its constant increase in costs. The market may have to make critical decisions in the future in terms of employees’ care and wellness and apply management strategies to avoid a total collapse. In this context, the services provided by brokers and consultancies are in great demand. On the other hand, to Brazilians, a healthcare plan is the most important and desirable benefit a company can provide, which underscores the importance to companies of keeping it.

…employers, who fund 80% of private healthcare, are facing difficulties maintaining healthcare as a benefit due to its constant increase in costs.

Overcoming the Barriers

In general, the South American systems all push against the same barriers:

  • Low-efficiency services operating under disease-focused, rather than health-focused, models (most system demands are linked to health recovery, while basic primary care is rarely incentivized)
  • Bad resource deployment with inefficient management and excess bureaucracy
  • Corruption and waste.

While we cannot ignore the need for judicious intervention in the health sector, there are still positive lessons to learn.

The Family Health Strategy in Brazil is an example of good practice in primary care. Under this program, trained community teams support individuals and families with their holistic well-being and enroll them proactively in the healthcare system, which promotes better health and helps prevent future complications. The coverage of the program is universal, but the fact is that not all citizens are being served due to the shortage of healthcare professionals.

Technological advancements are equally crucial positive steps forward. One example is the growing implementation of the Prontuário Eletrônico do Paciente (PEP), Electronic Problem-Oriented Medical Record. PEP logs patients’ medical data and provides a central database for other systems, consolidating information and so improving the quality of medical services. Telemedicine is another example of technology supporting medical care: it facilitates remote care and increases patient trust and speed of service. Although in its early stages, remote monitoring of health data and goal-setting could help bring down the number of unnecessary visits to medical units.

Despite these efforts, adequate funding and an efficient and transparent administration are fundamental to delivering sustainable health services. Although Brazil’s free and universally accessed healthcare is internationally recognized, it shows us a brilliant theoretical model is not enough.

Solving public and collective health problems is complicated. And it’s made more critical when you consider the fact that errors might cost lives and fast decisions can save them. With so many factors to be considered, in order to prevent these models from collapsing, all those with a role in healthcare must work together and have their voices heard.

Although Brazil’s free and universally accessed healthcare is internationally recognized, it shows us a brilliant theoretical model is not enough.

This is why the role of service mediators—insurers, operators, brokers and consultancies—is so important. Given their position in the market, they have the ability to undertake holistic analyses and propose corrective measures that may mitigate the risks and reduce companies’ exposures in this area. Many types of data, such as medical and administrative information, are available for modeling and evidence-based decision making.

All healthcare players, be they government, private initiative, suppliers or mediators, need to work together for their collective aim: to structure systems for sustainable funding and supply quality healthcare to the population.

Quintão is executive director of employee benefits at MDS Brazil. gustavo.quintao@mdsinsure.com

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