02.01.01. The public health system | Brazil

02.01.01. The public health system | Brazil

30 Mar 2022

The SUS was implemented in 1990. It is state-funded, it provides health services free of charge to the entire population, and it is one of the largest and most complex health systems in the world (Paim et al., 2011). In 2017, it accounted for 8.3% of national revenue, meaning 1.8% of the Brazilian Gross Domestic Product (GDP) in that year  (Brazilian National Treasure, 2018). The SUS provides a range of health services and interventions spanning the whole life-course (from the gestational period to the end of life). These include the primary, secondary, and tertiary levels of care; urgency and emergency systems; hospital care; health and environmental surveillance; and a pharmaceutical assistance program (Brazilian Ministry of Health, 2019k). The system is the major source of healthcare for low-income groups and those without access to private health insurance (Castro et al., 2019). According to the latest published version of the National Health Survey – 2013 (Pesquisa Nacional de Saúde – PNS), around 70% of the Brazilian population do not have private health insurance and therefore benefit from services provided by SUS or pay directly for private health services (Brazilian Ministry of Health, 2013a). The SUS is informed by local, municipal, state, and federal councils that aim to embed the population’s voices and needs into policy.


Brazilian Ministry of Health. (2013a). Pesquisa Nacional de Saúde 2013: Acesso e Uitlização dos Serviços de Saúde, Acidentes e Violências. https://biblioteca.ibge.gov.br/visualizacao/livros/liv94074.pdf

Brazilian Ministry of Health. (2019k). Sistema Único de Saúde (SUS): Estrutura, principios e como funciona. http://www.saude.gov.br/sistema-unico-de-saude

Brazilian National Treasure. (2018). Aspectos Fiscais da Saúde no Brasil. https://sisweb.tesouro.gov.br/apex/f?p=2501:9::::9:P9_ID_PUBLICACAO:28265

Castro, M. C., Massuda, A., Almeida, G., Menezes-Filho, N. A., Andrade, M. V., Noronha, K. V. M. de S., Rocha, R., Macinko, J., Hone, T., Tasca, R., Giovanella, L., Malik, A. M., Werneck, H., Fachine, L. A., & Rifat, A. (2019). Brazil’s unified health system: The first 30 years and prospects for the future. Lancet Health Public. https://www.abrasco.org.br/site/wp-content/uploads/2019/07/PIIS0140673619312437.pdf

Paim, J., Travassos, C., Almeida, C., Bahia, L., & Macinko, J. (2011). The Brazilian health system: History, advances, and challenges. The Lancet, 377(9779), 1778–1797. https://doi.org/10.1016/S0140-6736(11)60054-8