OECD Reviews of Health Systems: Brazil 2021

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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.

English Also available in: Portuguese


Over the past 30 years, Brazil has pursued policies to achieve universal health coverage. The Constitutional Reform of 1988 gave rise to the current Unified Health System (Sistema Único de Saúde, or SUS) and since the inception of SUS, virtually the entire population is formally covered by the public health sector, with equal benefits and equal financial protection. As a result, Brazil has significantly improved most general population health indicators, increased access to health care and reduced health inequalities. Life expectancy at birth increased by 5.7 years, from 70.2 years in 2000 to 75.9 years in 2019. Infant mortality rate has decreased by 60%, from 30.3 deaths per 1 000 live births in 2000 to 12.4 deaths per 1 000 live births in 2019. The same is true for maternal mortality rate which has decreased by 13 percentage points over the same period.

English Also available in: Portuguese

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