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Overview of Brazil's healthcare system, emphasizing primary health care and the Family Health Program. Discusses strengths and weaknesses, demographic aspects, and social context. Includes data on care provided and health indices.
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State of art in classification/ registration medical data in Brazil Gustavo Gusso Presidentof SBMFC MD, MClSc, PhD, FFPH
BRAZIL: Demographicaspects Territorial dimensions: 26 states, 1 Federal District, and 5.564 cities (withpolitical, ficalandadministrativeautonomy). 200 millionsinhabitants: 42,6% in Southeast 27,7% in Northeast 14,6% in South 8,0% in North 7,1% na in Center-West Fonte: IBGE
Human Development Index HDI - Brazil - 2000 HDI= 0,80 (70 position) BRAZIL: Social context
“UniqueHealth System” (SUS) – 1988/91 • Universality • Integrality • Equity • Social Control • Decentralization: PHC is Mayors responsability
Brazilian Health System: 20 years old Services provided by Públic Health System => 63.000 primary health care centers => 2 billions of procedures (include consultations) in primary care/ year => 725,4 millions ambulatorial procedures in specialized care/ year => 5.800 Hospitals units (441.000 beds) => 11,7 millions hispitalizations/ year
Our Goal Brazilian Health System Net
Countries with more than 100 milionsinhabitants • China • Índia • USA • Indonésia • Brazil • Paquistan • Bangladesh • Russia • Japan • Nigéria • México Whichhas na universal publichealth system? Whichonehas GP as gatekeeper?
Health System in Latin America • Brazil was one of the few countries who chose Beveridgian way • Most countries has different access to different work classes – more similiar to Bismarckian model
FamilyHealthProgram: 1994 - 2010 1998 2000 2002 2004 2006 2008
Family Health Program • 32000 teams • 100.000 inhabitants • 50% of all Brazilian population ( 25% Private system and 25% Bolchevique model)
Family Health Program • Captation finance + Incentive per team • Team: • GP or Family Doctor • Nurse • Assitant Nurse • Health Community Agents • 2400 to 4000 people
Strenghts of Brazilian Primary Health Care • The decision of the society for public health system (1988 Constitution) • The development after 1994 of a Primary Health System called in Brazil Family Health Program • Excellent immunization program (reaching more than 96% of all population), public rescue and transplantation services in public hospitals.
Evidences of Strenghts A 10% increase in Family Health Program coverage was associated with a 4.5% decrease in IMR, controlling for all other health determinants (p,0.01).
Weakness of Brazilian Primary Health Care • Payment by salary for Family Health Teams components • Each Family Health Teams covering 3000 people on average (up to 4000) • Family Health Teams covering a geographical area (patients has few options to choose their family doctor) • Most generalists from Family Health Teams not well trained
Weakness of Brazilian Primary Health Care • By constitution the role of Primary Health Care, as to run Family Health Teams, is exclusive to mayors and there is few involvement of governor of states. • Brazil spends 8,4% of its Gross National Product in Health System but 58,4% is private and 41,6% is public. • Private system (30% uses) dictate the culture of health as a product
Weakness of Brazilian Primary Health Care • There is no clear decision of upper classes if they want a strong public health system with universal coverage or strong private insurance companies. • Universities doesn´t have Primary Health Care and family medicine as core issues
ICPC in Brazil • Brazilwaspartofpilotof ICPC in 80`s (Ruy Laurenti) • Buyrights – 5 prices (2006/2008) • Translation (2008) • Publishandfree for download – www.sbmfc.org.br (2009)
ICPC in Brazil • Workshops in meetings (2009) • Politicalintervention (2009/2011) • TranHis for researchepurpose (2011 - )
One research • 29 doctors • Filled one form in all consultations during one week of each season • In the form the main question was: • What was the reason(s) for encounter • What was the problem you detected for each group of reason for encounter • 5698 consultation
Table 16: Most frequent problems when reason for encounter was fever
Table 19: Most frequent reasons for encounter when problem was Upper Respiratory Infection Acute
29 RFE = more than 50% of all encounters 28 Problems = more than 50% of all encounters • 1,625 RFE/ encounter 1, 475 Problems/ encounter • From most frequent problems in 39,6% one disease was diagnostiqued (if we consider hypertension, tabacco abuse, obesity as risk factors) • Data similar to other studied but patients different = episode is essential
Limitations • It was paper based so encounter based and not episode (although I could estimate pre test probability because I confronted RFE and problems) • It is only mandatory to register ICD 10 in Brazil for hospitalization and referrals purposes (as to specialists or for some exam)
Limitations • There is one really poor PHC System to collect data as pneumonia in children less than 5 years old and strokes • There are hundreds of systems to collect data regarding mortality (SIM), pap smears (SisColo), disease of compulsory notification (as dengue and malaria) – surveillence system • DataSus – www.datasus.gov.br
Opportunities • Growing interest for “GP technology” • Quickly informatization of system • Demand for technology as Episodes • Certification of EMR: work for Municipalities as Rio de janeiro and São Paulo and Ministry of Health (mayors demand and pay for it)
