Universal health coverage includes strengthening the SUS in Brazil, says the specialist

Celebrating International Universal Health Coverage Day in Brazil means standing up for the expansion of resources to fund the Unified Health System (SUS) which, despite being one of the largest in the world by population, is still not enough.

This is the opinion of Dr. Ligia Giovannila, Senior Researcher at the National School of Public Health of the Oswaldo Cruz Foundation (ENSP /Fiocruz🇧🇷

With extensive experience in group health, she notes that on the 12th of this month, it’s important to understand the difference between universal coverage and universal access.

For the specialist and member of the Fiocruz Center for Strategic Studies, these two concepts of universality in health have intensified international debate in recent years.

If there is an incentive in the concept of universal health coverage to obtain differentiated health insurance according to the ability of individuals to pay, then there is no definition of a limited basket in the universal health system: services must be provided according to the needs of the population.

“Universal care is one of its principles; everyone should receive attention according to their needs, not on the basis of merit or income,” says Lígia.

Comprehensive coverage

Promoted by international organizations such as the World Bank and the World Health Organization (WHO), the idea of ​​universal coverage has been incorporated into United Nations resolutions (United nations🇧🇷

In Legia’s understanding, there is skepticism about this concept created by the relationships between the World Health Organization, the Rockefeller Foundation, and the World Bank.

In European countries, universal generally refers to the general coverage of national systems, under names such as Comprehensive health care or Comprehensive health systemshe explains.

The doctor points out a contradiction in this concept. He notes that the term is used in developing countries for basic services or health insurance coverage, whether public or private, “with an emphasis on supporting demand at the expense of building global public systems”.

Lígia says that health coverage with a type of insurance, whether public or private, does not necessarily guarantee access to health services according to needs.

That is why, in Brazil, we advocate for the SUS, which gives universal access to all citizens residing in the country. This differs from private insurance coverage which, in general, covers what is in their contracts, with a payment that is not only dependent on the people’s ability to pay, but on the health risks presented by the contractor,” he asserts.

For the researcher, the private system is not supportive and does not cover all health needs of the population.

Acute attack of SUS

Lígia states that the SUS budget has always been insufficient to deal with a global system. “It always has been, but it remains severely underfunded with Constitutional Amendment (EC) 95, which must be repealed to ensure universal care and universal access,” he points out.

The researcher continues, EC 95, by freezing public spending on health in such a way that even if a country increases its revenues, it will not be able to adjust its spending on health.

Which she considers a contradiction, as it is an area where costs are increasing due to constant changes in epidemiological and demographic profiles.

“Fortunately, people in Brazil live longer, but this also brings special care needs to this group,” he wonders.

Despite all the difficulties, the Brazilian system, due to its decentralization, through the initiatives of governors and mayors, has shown all its value during the pandemic, he said. And he asserts: “If it were not for the SUS, we would definitely have more deaths and more suffering for the population.”

Setbacks and inefficiencies

Although it was not part of the healthy transition group of the new government that will take power in January 2023, Lígia had access to parts of the diagnosis being finalized in the coming days.

“There is a series of setbacks and all the incompetence of the health management of the outgoing government, which is responsible for at least half of these deaths from coronavirus in the country,” he notes.

According to her, the proposals were straightforward “in the sense of expanding SUS funding so that we actually have a system that covers the entire population in their needs and can handle all the demand pent up by the pandemic in terms of access, with queues for different specialties and elective surgeries; and allowing us to expand coverage and access for our method of primary health care, such as the Family Health Strategy,” he lists.

family health worldwide

Lígia states that the family health strategy is no longer a priority in Bolsonaro’s government.

“It must become a priority again, because this model of care, with specialized multidisciplinary teams, has shown, according to research, results that have a very positive impact on the health of the population.”

The specialist lists examples, such as reducing infant mortality, reducing hospitalizations avoided through primary care, reducing inequality of access regionally and reducing inequality of access for the elderly.