Presentation prepared for an International Conference organised by the Centre for Public Policy, Indian Institute of Management, Bangalore,

December 30, 2011. This research was sponsored by the Centre for Budget and Policy Studies, Bangalore. I am grateful to Brazilian scholars and government officials who gave me generously of their time. I visited health institutions in Brasilia, Manaus, Belo Horizonte and met with professors in Rio de Janeiro, Recife and Sao Paulo in addition to the other cities. This is an overview study of the system, not a evaluation of what Brazil has achieved. Responsibility for errors of fact and opinion is mine alone.

See also: http://portal.saude.gov.br/portal/arquivos/pdf/financing_health_policies_in_brazil.pdf. http://www.lachsr.org/documents/healthsystemprofileofbrazil-EN.pdf of 2005, is a useful reference.

The Gini Ratio has reduced from 5.8 to 5.2...swtill very high. In India it is 3.8.

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See also http://worldfocus.org/blog/2009/01/26/the-highs-and-lows-of-universal-healthcare-in-brazil/3768/. This is from a US perspective, and sees a competition for resources between primary care and tertiary care. I see it as underfunding of health as a whole.

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See also http://siteresources.worldbank.org/SOCIALPROTECTION/Resources/0527.pdf. http://www.ipcundp.org/doc_africa_brazil/Webpage/missao/Artigos/CadastroUnicoJoanaMostafa.pdf.

The central idea is to collect and keep updated, through decentralized data entry, a concise number of variables with clear and standardized response options. The relatively easy-to-use format of the questionnaire as well as the proximity to the data generating fact ensures more precision and enables faster updating processes. Alongside, the decentralization as well as the standardization of the responses guarantees, on the one hand, national coverage, on the other, utility for national policy makers usage.

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UPA: Units of Prompt Assistance. There are complaints of loing waiting times at UPAs. This could be due to underfunding of the health as a whole. See also http://www.scielo.br/pdf/rsp/v45n3/en_2335.pdf.

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Often also teaching hospitals attached to universities.

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Launched after careful preparation.

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Named Osvaldo Cruz after a pioneer in health policy.

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Guarana is grown in the region and has many uses. It is like our traditional cereal like ragi, slow in digesting. A processed version is available as a soft drink in other parts of the country. I saw some packets being sold as a Amazon viagra.

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I have heard that members of the Commission are retred executives of the insurance companies, and some argue they have been captured. They have introduced some reformsshift from one company to another, some uniformity in the plans and rates etc. They have also regularly approved increases in premia.

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We need to understand this complaint about waiting. It is trotted out as a problem whenever we discuss public provision of a service. In Bangalore, we have to wait at private hospitals, sometimes for two hours, after paying the full fee. If we ask for service to be on arrival, then the level of investment will be very high. For non emergency matters, good organisation together with moderate wait should be acceptable.

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As I see it...

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My views...

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