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Brazil's SUS Offers Cautionary Tale for Universal Health Care

us healthcareWhile U.S. soccer fans are watching the World Cup action in Brazil with great excitement, U.S. health organizations may want to pay more attention to country’s universal health care system.

Proponents of universal health care often point to successful Northern European systems as templates for reform in the US, but those countries don’t offer practical models.

The state of Minnesota alone is larger and more diverse than the whole of Finland.

The sprawling diversity of Brazil, on the other hand, offers a more accurate reflection of what the U.S. is up against. And the challenges Brazil has faced in maintaining its Sistema Único de Saúde (SUS) offer lessons for our own journey toward improving patient outcomes.

25 Years of Universal Health Care in Brazil

A recent article in The Atlantic notes that in the decades prior to the introduction of universal health care, Brazil’s health indicators “lagged far behind those of its neighbors.” After the collapse of the military-led government, a newly drafted Brazilian constitution guaranteed free public health care to its citizens.

Compared to the state of national health care in 1988, Brazil has made great strides in improving patient outcomes:

  • Infant mortality dropped 48 percent since 2000.
  • Maternal mortality dropped 50 percent since 1990.
  • Average life expectancy has increased 8-years, from 66 to 74, since 1990.

Yet, despite these gains, doctors interviewed by The Atlantic reporter, Olga Khazan, say that Brazil’s universal health care system functions like “a safety net with holes.”

In a poll conducted in Brazil last year, nearly half of the respondents cited health care as the nation’s biggest problem.

While the wealthy access private physicians thanks to “American-style” insurance offered by employers, a large portion of the population — living in remote areas and burdened by poverty — struggle to get the care they need. Sound familiar?

Mixed Results from a Complex System

What’s causing the dissatisfaction? The economic disparity among Brazil’s people is a serious challenge.

There is a clear dividing line between poor patients in the north and wealthy patients in the south, leading to serious health care inequities. The infant mortality rate in the north is double that in the south, likely due in part to a gap in prenatal care among poor and rich. To highlight the north-south inequality further, between 62 to 75 percent of patients in the south received necessary kidney transplants but in the rest of the country, the transplant rate hovered between 13 to 27 percent in 2012.

As in the U.S., where roughly 20 percent of the population lives in regions with physician shortages, northern Brazil also struggles with a shortage of health care practitioners and medical facilities to serve the often remote locations.

It seems it’s just as difficult to convince Brazilian physicians to leave the comforts and financial incentives of southern urban settings for the Amazonian jungle as it is to get an American doctor to leave the Big Apple for the lonely, big skies of Montana. 

And to top it all off, a growing middle class in Brazil has contributed to a particular health care challenge that physicians in the United States may find strikingly familiar. With more disposable income, Brazil’s middle class has gone on a junk food binge, leading to an alarming increase in instances of obesity and obesity-related diseases — which often go without adequate care thanks to an alarming shortage of trained medical professionals and the poverty and remoteness of patients.

Improving on Brazil’s Example

With such striking similarities between challenges inherent in our own system and those faced by the SUS, the startling inadequacies seen in Brazil s offer a stark warning for American officials.

Providing care to a diverse nation is not easily done.

Health care organizations that hope to make progress in improving patient outcomes during this transformational period will need the right tools. As Brazil’s experience proves, a diverse population creates unique challenges.

One such tool may be psychographic segmentation, allowing your organization to drive patient activation by fine-tuning provider/patient interactions. Psychographic segmentation allows you to transcend demographic and socioeconomic differences to effectively engage consumers based on their individual motivations for better health outcomes.

Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change


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