Brazil has the most comprehensive healthcare system in the world. Importance SUS It was clear During the recent Covid-19 pandemic, which generated more demands for its promotion. One of the most notable points is related to its financing.
Although the level of total health spending in Brazil (about 10% of GDP) is comparable to that of European countries such as Denmark, the Netherlands and the United Kingdom, or Argentina, Chile and Uruguay, in Latin America a smaller proportion of this total spending is financed by the sector. Overall: just under 41% in Brazil, compared to 62% in Argentina, 67% in Uruguay, 72% in Colombia, and over 80% in Denmark and the United Kingdom.
This means that most health financing in Brazil is done by the private sector, and an important part of this spending is directly paid to households: approximately 15% of health spending in Brazil is paid for by Brazilian families. In Colombia, this percentage is about 4%.
The main problem with this family spending is inequality: its weight falls disproportionately The poorest and most vulnerable groups🇧🇷 The main driver of these individual expenditures is concentrated in one category: class Pharmaceutical products🇧🇷
Medical needs can be unpredictable, and the consequences sometimes go beyond health effects. Absenteeism from work and spending on doctors, exams and medication can strain family budgets and even lead to poverty.
Although public health is free in Brazil, the latest data from the Household Budget Survey shows that Brazilian families spend, on average, 13% of their budget on health, being the fourth consumption group after housing, transportation and food. The problem is that this is an average expense, and some families spend much more than that, which can hurt the ability to buy food and pay the bills for the month.
High health expenditures are so troubling that the economic literature often describes them as catastrophic expenditures. The World Health Organization (WHO) works with various reference lines for what is considered high expenditure, including an amount greater than 10% of the household budget. A recent World Bank study showed that 37% of households spend more than 10% of their budget on health. Among the poorest, these health expenditures amount to nearly 40% of the household budget.
The study identifies the most vulnerable groups: households headed by women, those in rural areas that are less educated, and in particular families with elderly people. Elderly population growth in Brazil One of the fastest growing companies in the worldis expected to increase from 11% of the working-age population in 2005 to 49% in 2050, indicating that families’ concerns about health expenditures tend to increase.
On average, medicines account for 46% of Brazilian household health expenditures, but this percentage varies greatly by income group. For the poor, 84% of spending on health goes to medicines, compared to 29% for the richest families, almost three times less.
These data clearly show the importance of the debate at this moment about the need to improve access to medicines for Brazilians, especially the poorest. It is necessary to deepen this discussion and inform the development of pharmaceutical policies that lead to more equitable access to medicines and reduce the negative impact of health expenditures on the most vulnerable Brazilians.
This column was written in collaboration with my colleagues at the World Bank: Roberto Iones, Chief Economist, Courtney Ivins, Health Expert, and Bernardo Coelho, Consultant.
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