The unified health system of Brazil and the effectiveness of health services

Aim The public health sector in Brazil covers approximately 75% of the population, yet accounts for just 45% of total health expenditure, while the private sector, covering 25%, spends 55% of the resources. The objective of this study, therefore, was to estimate the effectiveness of public and private health activities in Brazil. Subject and methods The study uses data from the time period covering 2008 to 2015, a period when there was considerable economic growth and also an expansion of private health insurance. Using data from 5568 municipalities, the logarithmic linear multivariate regression model was used to estimate the impact of the two sectors on infant, maternal, and preventable diseases mortality rates from 5 to 74 years of age. Results The data showed that in public basic care, the number of public treatments increased 55% in medium complexity cases and 36% in high complexity cases, while private expansion was 19% and 18%, respectively. For hospital admissions, the public sector expanded by 9% in medium complexity cases and 21% in high complexity cases, while private sector admissions decreased by 18% and 43%, respectively. In terms of impact, the number of child deaths fell by approximately 13%. The estimate suggests that, with a 95% confidence interval, an increase of one public establishment per thousand inhabitants reduces, on average, by 189.4% the infant, maternal, and preventable disease mortality rates from ages 5 to 74 years, whereas an additional private establishment per thousand beneficiaries reduces the above mortalities by just 1.9%. Conclusion Underfinancing of public sector health services seems to be the central issue for the development of better public health outcomes in Brazil.