Does primary care access act as a gatekeeper system for access to secondary and tertiary care? | Brazil Does primary care access act as a gatekeeper system for access to secondary and tertiary care? | Brazil

30 Mar 2022

The primary care system is conceptualized for acting as a gatekeeper system. This is one of the aims in the provision of health care in Brazil. The primary care model is in line with the provision of universal access and comprehensive healthcare, it aims to coordinate  the access to specialist and hospital care, and it promotes actions for health promotion and disease prevention (Paim et al., 2011). Investments and organisational strategies, such as the establishment of the Community Health Agents Programme and the Family Health Strategy – FHS, have been carried out and have been helpful to reorganize primary care clinics to focus on the community and to integrate medical care with health promotion and public health actions (Brazilian Ministry of Health, 2019d; Paim et al., 2011).

In addition, more investments in decentralized and computerized regulatory systems have been made by municipalities. These result in the possibility of monitoring of waiting lists for specialized care, increase of service supply, introduction to clinical guidelines, and use of electronic medical records. These strategies end up integrating primary healthcare with the network of specialised services (Paim et al., 2011). According to a study conducted in four Brazilian capitals, referrals to secondary care services that come from family health care teams are usually more effective and have shorter waiting times (Almeida et al., 2010). Although all these advances have been achieved, it is necessary to remember that the primary care system in Brazil may be circumvented by people willing to pay out-of-pocket to access services immediately.


Almeida, P. F. de, Giovanella, L., Mendonça, M. H. M. de, & Escorel, S. (2010). Desafios à coordenação dos cuidados em saúde: Estratégias de integração entre níveis assistenciais em grandes centros urbanos. Cadernos de Saúde Pública, 26(2), 286–298. https://doi.org/10.1590/S0102-311X2010000200008

Brazilian Ministry of Health. (2019d). Estratégia Saúde da Família (ESF).

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