The Health Care System of Brazil

Abstract

The Brazilian healthcare sector is the largest medical device and economy market in Latin America and it is ranked as fourth most attractive market in commercializing a medical device. The health system of Brazil is categorized in two private and public health systems. A comparison between Brazil and United States indicates that the US has more uninsured citizens. This is in contrary to Brazil which provides free medical facilities where all citizens have a constitutional right to free and accessible health. HIV/AIDS was identified as the major Health problem facing the country. The reason for choosing this health problem is because the country is represented by the largest number of individuals living with HIV in Latin American where it comprises of 40% of all new HIV infection in the region. The health system has achieved much in regard to this medical issue. For example, the incidence rate has reduced tremendously in the past years. HIV is influenced by social, cultural, political environmental and political factors. There are gaps that need to be filled in the efforts of reducing HIV infection rate. The major factor that healthcare system should consider is behavioural change of the citizens by use of behavioural intervention that targets both the infected and uninfected individuals

The Health Care System of Brazil

Brazil is a large country in South America, in the South; there is a massive Iguaçu Falls while in North there Amazon Basin to vineyards. The official language of the country is Portuguese and has a population of 207.8million. Brazil comprises of one Federal District (Brasilia) and 26 states. Its president is Michel Temer, and the capital city is Brasilia.  The types of government in the country are; Constitutional Republic, Federal Republic, and Presidential system. The country is well known for its Ipanema beaches, its busy Copacabana, and Rio de Janeiro symbolized by Christ the Redeemer statue atop Mount Corcovado which is 38m.

Healthcare System

The healthcare market of Brazil is large, expensive and requires improvement. Deloitte, (2015) states that in the estimate; the healthcare spending was $208 billion in 2013 which was approximately 9.1% GDP. 75% of the 207.8 million people rely on free care from the Brazil’s Unified Health System (SUS) which in the world, it is the largest health system. The rest (25%) are enrolled in a private health plan. The Brazilian healthcare sector is the largest medical device and economy market in Latin America. In the America region, it is ranked as the fourth most attractive market in commercializing a medical device.

The Brazil’s health system is segmented, mixed and acquires its finances sources from two subsystems: one private and one public. PAHO (2010) explains that the private subsystem has two segments, which benefits from the fiscal incentive. One offers health plans and insurance and is referred as a supplementary system; it is financed with resources from employees and employers, non-compulsory, and voluntary participation. The second provides direct access to private providers by making payments while receiving care. 

In the public system, there are two segments. The first one offers free universal access which is financed entirely by government resources, known as Unified Health System (SUS). Every individual in the country has a right to free health. The second segment provided restricted access to government employees (military and civilians), employees contributions and financed with public resources. The public system ensures accessibility to 75% of the population (PAHO, 2010). The population that is covered by the private system also benefits from the public network in the form of public health activities.

Comparison of Brazil and US Healthcare System

In comparison to Brazil, the US has a high number of uninsured citizens. Nascimento (2013) explains that in the US, roughly 17% of its citizens are uninsured and the government generated strategies to increase access where they have affected many healthcare institutions in America by adapting and widening the scope to reach more citizens. The US faces skyrocketing costs of medical procedures that create the issue of reduced access. This has led to increased number of people being left out of the system without healthcare services access. The majority of the underinsured finds themselves with financial difficulties for healthcare payment. In the United States, medical expenses are the primary cause of personal bankruptcy filings. 

On the other hand, the growing Brazil economy uses a government structure that operates everything in healthcare; from sex reassignment surgery to medicines. According to Nascimento (2013), the policy is guided by the government towards the constitutional right of the Brazilians to universal healthcare access. This makes the Brazil health market to be strict with its performance. In Brazil, the general concern about socialization is whether the government knows it all, while in the US is; has the government gone too far. 

In both United States and Brazil, there is need to consider a healthcare reform as an essential step towards proper equilibrium of efficiency, economy, effectiveness, and equity. This is due to the unbalanced pillars of public administration. For example, in the case of US, the issue of healthcare provision equity has a long way to go due to the high number of citizens (17%) without healthcare access. In Brazil, health care is recognized as a constitution right that eases the accessibility of health system to every person irrespective of their financial status.  On the other hand, Brazil has a long way to go due to the low level of investments in medical research creating a barrier to the availability of new technologies, medicines, and new treatments. On the contrary, the United States has laid high investments on medical research. 

HIV/AIDS in Brazil

Epidemiology

Overview

In 2002, the Brazilian Ministry of Health (MoH) and UNAIDS estimated that at the end of 2001, 610,000 Brazilians were living with HIV/AIDS, with an adult prevalence of 0.7%. However, the estimates are subject to variation as HIV infection is not reportable in Brazil, unlike AIDS. In July 2004, a revised county level data was released by UNAIDS, which estimated that there were 660,000 at the end of 2003, Brazilians living with HIV/AIDS (Bacon, Pecoraro, Galvão and Page-Shafer 2004). The UNAIDS states that the HIV/AIDS epidemic has been stabilizing, with all regions except the South having a reduced AIDS incidences being reported. 

The HIV/AIDS epidemic in Brazil relies on mandatory case reporting rather than HIV incidence and prevalence studies. Bacon, Pecoraro, Galvão and Page-Shafer (2004) state that in comparison to HIV prevalence studies, case-based surveillance is helpful in the allocation of resources for patient care, but it is of limited in leading the efforts of prevention. This is because of widespread and high use of antiretroviral therapy (HAART) that delays the disease progression. Also, the appearance of symptomatic disease is preceded by the infection by 8-10 years.

Transmission Patterns

Grounded on AIDS case reporting, the epidemic of HIV/AIDS has shifted from socioeconomically advantaged to those that are less advantaged, from homosexuals acquisition to heterosexual acquisition, from men to women, from industrialized Southwest cities to all other sections of the country. Overall, according to Bacon, Pecoraro, Galvão and Page-Shafer (2004), the ratio of male-to-female among AIDS cases has reduced from 24:1 in 1985 to 2:1 in 2002. The incidence continues to stabilize due to widespread HAART availability, continuous prevention initiatives and saturation of core groups. Measures were taken Against the Epidemic

The government and health care professionals ensure early access to care by use of voluntary counseling and testing (VCT). The already infected individuals are encouraged to adhere to their ARV therapeutic regime as lack of adherence causes the emergence of resistant HIV strains, deterioration of immune system and therapeutic failure. Brazil health systems give psychosocial support and protect the human rights of People Living with HIV/AIDS (PLWHA) (Bacon, Pecoraro, Galvão and Page-Shafer 2004. The country also ensures that health care professional is well trained as it also reduces the unintended ARVs universal access. Among the middle-income countries, Brazil is the only country that provides universal and free access to antiretroviral (ARV) therapy

HIV/AIDS as a Global Issue

Globally, HIV is a public health problem that affects all regions in the world. According to WHO (2016), HIV/AIDS has claimed more than 35 million lives, whereby in 2015, the number of death due to HIV- related causes were 1.1 (940 000–1.3 million) million. Globally, at the end of 2005, 36.7 (34.0–39.8) million people were living with HIV and 2.1 (1.8–2.4) million people were getting infected. The most affected region is Sub-Saharan Africa with 25.6 (23.1–28.5) million living with HIV. According to WHO estimates, only 60% of people with HIV who are aware of their status. Therefore, HIV/AIDS is not only an issue in Brazil but a global problem affecting all regions in the world. 

Social, Cultural, and Economic Factors Influencing HIV in Brazil

Although HIV/AIDS was named as the disease of poverty, there is a complex relationship between HIV prevalence and socio-economic indicators. Globally, the most affected area is Africa, but at the country level, the richer countries’ are more affected thus breaking the relationship between poverty and HIV infection. The same criteria apply in Brazil; it cannot be termed that the financially disadvantage persons are highly infected and are at greater risk than the financially advantaged individual. 

Education is another factor influencing HIV vulnerability in Brazil that occurs due to social changes that increase the likelihood of infection. While in the education system, a person is prone to meet new people, make friends and interact with them thus increasing intimacy. The behavior of an educated individual is different from that of uneducated as they tend to live ‘civilized.’ Another environmental and social factor linked with high HIV/AIDS rates is high migration rates and war conflicts which increase sexual networking. 

Social Factors

The Brazil’s indigenous population is estimated to be 350,000, with 80% living in villages distributed in reserves, and they occupy about 11%. In Brazil, HIV/AIDS is an emerging issue for indigenous people, where the introduction of the epidemic is believed to be from miners traveling between Brazil and Southern Venezuela border. Aboriginal women of some ethnic are at higher risk of contracting HIV as the miners’ spouses. The cases of AIDS among the indigenous people are more concentrated among young adults living in mid-size municipalities and cities in North, Centre, and West. Between 24-34 years, the rate is 68% with female cases as 79.2% and male cases at 65.2%. The majority of the reported cases it involves Indians living in urban areas especially women who were interacting with surrounding communities. Some of the risk factors influencing these rates among the group include alcoholism, commercial sex work, and poverty.  

Another social factor influencing HIV/AIDS transmission in Brazil is population mobility. In the country, there is widespread internal migration with 16% living in the different federal state and 41% living in communities that are not their birth communities. Northeast is a clear reflection of male population exodus where the majority of young women migrated to the Southeast in search of economic opportunities leaving their wives and children behind. The men are vulnerable to HIV, and they infect their wives. Long distance truck drivers are prone to HIV infection which was illustrated by a study conducted among 279 truck drivers in Santos. The results demonstrated that 19% of the men were having sex with another regular partner, 40% were having sex with casual female partners, and 93% had a stable partner. Some of the factors contributing to their vulnerability to HIV infection are staying for long periods away from their spouses and inconsistent use of condoms.

Political and Economic Factors

From mid of 20^th century to 1985, the Brazil’s political rule alternated between civilian dictatorship and military. Between the 1960s and 1970s, there was massive economic growth and industrial development underwritten by foreign loans. The 1980s slowing growth brought rampant inflation, the debt crisis and vigilant return to civilian rule in 1985. During the new constitution time in 1988, Brazil faced massive socioeconomic status inequalities which affected the public health sector due to high, inadequate spending. 

Types and Levels of Threat Posed by HIV to the USA

HIV remains a serious health problem in the United States. In 2010, approximately 47,500 people became newly infected. The incidence of HIV in the US has remained relatively stable with 50,000 new infections yearly since the mid-1990s. According to analysis, in 2010 there were 47,500 infections; 2008 were 47,500; 2009 were 45,000; and in 2010 they were 47,500. Certain groups including Latinos, African American, bisexual and gay men, of all ethnicities and races continue to be disproportionally affected by HIV. By age, the largest percentage of new HIV infection in 2010 transpired among individuals between 25-34 (14,500; 31%), followed by 13-24 (26%; 12,200) and later 35-44 (24%; 11,300) (CDC, 2016). Therefore, although HIV incidence is persisting at far too high a level, it can be reduced by more than 2/3 due to the height of US HIV prevention and HIV epidemic which have been estimated to prevent 350,000 infections in the US. In the US, the rate of infection has decreased due to effective programs on HIV testing, prevention, and treatment.

Ways in which Brazil Health System is Equipped against HIV

The World Bank in 1994 estimated that Brazil would report approximately 1.2million HIV infection cases by 2002. However, the estimates by the end of 2000 were 500,000 cases which were more than 50% of previous estimates. The health system by 2001 cared for more than 120,000 AIDS patients under the PN-DST/AIDS. The mortality rate attributed to HIV/AIDS was reduced between 60% and 80% as well as opportunist infections incidences. This situation was reflected by attributable hospital admission in AIDS reduction. Approximately, 358,000 admissions were evaded between 1997 and 2001 which set aside the US$1billion for the country. 60,000new AIDS cases have been prevented by the Brazil national treatment program, saving approximately US$1.2 billion in ambulatory care. Also, an estimate of 3,700 pediatric cases is restricted from the introduction of Prevention of Mother-to-Child Transmission (PMTCT) prophylactic therapy.

Healthcare System Changes

HIV/AIDS is a preventable condition that can be prevented by behavioral changes. The healthcare system of Brazil should incorporate behavioral changes intervention to promote the health of the infected as well as prevent transmission of the disease so as to reduce the incidence rates. According to Coates, Richter, and Caceres (2008), there are five key points that Brazil should include in the health care system. The first is the use of the aggregate effect of sustained and radical behavioral changes to persons at risk so as to reduce the rate of transmission. The second key aspect to include in the health system is the use of combination prevention as the transmission of HIV is neither simplistic nor straightforward. To reduce HIV transmission, sustained and widespread communication channels mix for disseminating information so as to engage and motivate people in range options for risk reduction. 

The health system should invest more in a prevention program.  The behavioural strategies’ effect should be increased by targeting many goals (for example, increases in the use of condoms to condense the number of sexual partners, delay in onset of first intercourse, and others.) which are achievable by use of multilevel approaches (e.g., sexual network, families, sexual and social network, entire community, institutions or couples). These interventions should target both the uninfected and infected. The Brazil system should employ the Science of Prevention in its efforts of HIV reduction. Interventions that are generated from behavioral plays a significant role in overall efforts of HIV prevention. However, these interventions require combination with other interventions for lasting and substantial HIV transmission reductions in an entire community or between individuals. The fifth key point that can be adapted by Brazil is getting the simple things right. This is by agreeing on the HIV prevention fundamentals, funding them, implementing, measuring and achieved.

References

CDC. (2016). HIV in the United States: The Stages of Care. CDC Fact Sheet. Retrieved from https://www.cdc.gov/nchhstp/newsroom/docs/HIV-Stages-of-Care-Factsheet-508.pdf

Bacon, O., Pecoraro, M. L., Galvão, J., & Page-Shafer, K. (2004). HIV/AIDS in Brazil. San Francisco: AIDS Policy Research Center, University of California.

Coates, T., Richter, L., & Caceres, C. (2008). Behavioural strategies to reduce HIV transmission: how to make them work better. The Lancet, 372(9639), 669-684. http://dx.doi.org/10.1016/s0140-6736(08)60886-7

Deloitte. (2015). The 2015 Healthcare Outlook-Brazil. Ndustry Report, Healthcare: Brazil , The Economist Intelligence Unit. Retrieved from ttps://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/gx-lshc-2015-health-care-outlook-brazil.pdf

Nascimento, I. (2013). Healthcare Systems in Brazil and the United States: A Comparative Analysis. Dissertations, Theses And Capstone Projects. Paper 567. Retrieved from http://digitalcommons.kennesaw.edu/cgi/viewcontent.cgi?article=1567&context=etd

PAHO. (2010). Health Systems and Services Profile Brazil. Pan American Health Organization. Retrieved from http://new.paho.org/hq/dmdocuments/2010/Health_System_Profile-Brazil_2008.pdf

WHO. (2016). HIV/AIDS. The World Health Organization. Retrieved from http://www.who.int/mediacentre/factsheets/fs360/en