Skip to main content
SpringerLink
Log in

Political and Institutional Drivers of Social Security Universalization in Brazil

  • Chapter
  • First Online:
Towards Universal Health Care in Emerging Economies

Part of the book series: Social Policy in a Development Context ((SPDC))

Abstract

Brazil’s experience in building a relatively successful universal health system was made possible by the combination of political incentives to serve poor constituencies, which made it politically sustainable; fiscal sustainability and the great extractive capacity of the Brazilian state; and the institutional capacity to run a complex decentralized system. This chapter argues that Brazil’s Unified Health System (SUS) has faced two important challenges: finding new financial resources for the sector and promoting efficiency gains. Finding new sources of funding has involved unprecedented political costs despite the increasing saliency of public health in the public agenda. Efficiency gains are also unlikely to occur in the near future due to the recent deterioration of public sector management since 2012 and other specific factors, including the judicialization of health care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    The World Health Report 2010 defines the principle in prima facie similar fashion: universal health coverage as a target in which “all people have access to services and do not suffer financial hardship paying for them” (WHO 2010: 9). But this definition involves a consideration of capacity to pay that is absent from the former definition. As is demonstrated in this chapter, this has produced some perversity in the SUS system.

  2. 2.

    See Skocpol (1991), Antonnen (2002), Mkandawire (2005) and Antonnen et al. (2012). Social security is also a contested concept with regional variations in the usage of the term. Whereas in the US it refers primarily to old age, survivors and disability insurance, and welfare, in Europe as well as in Brazil, after 1988, it denotes social assistance, pension provisions and health care.

  3. 3.

    The Partido do Movimento Democrático Brasileiro was the main opposition party under the dictatorship and the Partido da Frente Liberal was founded by a group of defectors from Arena, the party that supported the military regime.

  4. 4.

    Interestingly, most urban unions—along with senior bureaucrats in the planning and finance ministries—opposed this move, arguing that it might jeopardize the financial basis of the system, but it was strongly supported by the Confederation of Agricultural Workers (Contag) and by reformist legislators and bureaucrats.

  5. 5.

    Previously, patients had to produce proof of an employment relationship prior to being admitted to the system.

  6. 6.

    Rudra and Haggard (2005), Segura-Ubiergo (2007), Rudra (2007).

  7. 7.

    Since the time of writing, another presidential impeachment has taken place—that of Dilma Rousseff—amidst a large corruption scandal, political instability and a severe economic recession.

  8. 8.

    Latin American Public Opinion Project (LAPOP) 2012 data. Accessed 13 February 2014. www.vanderbilt.edu/lapop.

  9. 9.

    Saúde + 10 is a proposal for health expenditure to be earmarked at 10 percent of current federal expenditure.

Bibliography

  • Alston, Lee, Marcus André Melo, B. Mueller, and C. Pereira. 2013. Changing social contracts: Beliefs and dissipative inclusion in Brazil. Journal of Comparative Economics 1: 4–22.

    Google Scholar 

  • Antonnen, Anneli. 2002. Universalism and social policy: A Nordic feminist reevaluation. Nordic Journal of Gender Research 2(70): 70–84.

    Google Scholar 

  • Antonnen, Anneli, L. Haikio, and K. Stefansson (eds.). 2012. Welfare state, universalism and diversity. Cheltenham: Edward Elgar.

    Google Scholar 

  • Barrientos, Armando. 2013. The rise of social assistance in Brazil. Development and Change 44(4): 887–910.

    Article  Google Scholar 

  • Biehl, J., Adriana Petryna, Alex Gertner, Joseph J. Amon, and Paulo D. Picon. 2009. Judicialization and the right to health in Brazil. The Lancet 373(27): 2183.

    Google Scholar 

  • Carnes, Matthew, and Isabella Mares. 2012. Risk and reversals: Explaining individual-level support for public social insurance expansion in Latin America. Paper prepared for presentation at the annual meeting of the American Political Science Association, New Orleans, 29 August–2 September 2012.

    Google Scholar 

  • CNI (Confederação Nacional da Indústria). 2012. Retratos da sociedade brasileira: Saúde pública. Pesquisa CNI-IBOPE. Brasilia: CNI. http://ecos-redenutri.bvs.br/tiki-download_file.php?fileId=92. Accessed Mar 2016.

  • ECLAC (Economic Commission for Latin America and the Carribbean). 2009. CEPALSTAT databases and statistical publications. http://estadisticas.cepal.org/cepalstat/WEB_CEPALSTAT/Portada.asp?idioma=i. Accessed 23 Oct 2012.

  • Faletti, Tulia. 2010. Infiltrating ‘The state’: The evolution of health care reforms in Brazil, 1964–1988. In Explaining institutional change: Ambiguity, agency, and power, ed. James Mahoney and Kathleen Thelen, 38–62. New York: Cambridge University Press.

    Google Scholar 

  • Gragnolati, Michele, Magnus Lindelow, and Bernard Couttolenc. 2013. Twenty years of health system in Brazil: An assessment of the Sistema Único de Saúde. Washington DC: World Bank.

    Book  Google Scholar 

  • Kuhn, Diane Marie. 2012. Health care reform in Mexico and Brasil: The politics of institutions, spending and performance. PhD Dissertation in Government, Harvard University.

    Google Scholar 

  • Leite, Adailton Amaral Barbosa. 2010. Descentralização, responsabilização e (des) controle: Determinantes e impactos da corrupção e má gestão dos recursos federais nos municipios brasileiros. PhD Dissertation in Political Science, Universidade Federal de Pernambuco.

    Google Scholar 

  • Longo, Francisco. 2006. Análisis comparativo por indices. In Informe sobre la situación del servicio civil en América Latina, ed. Koldo Echebarría, 573–592. Washington, DC: Inter-American Development Bank.

    Google Scholar 

  • Mares, Isabella, and Matthew Carnes. 2009. Social policy in developing countries. Annual Review of Political Science 12: 93–113.

    Article  Google Scholar 

  • Medici, A. 2003. Family spending on health in Brazil: Some indirect evidence of the regressive nature of public spending in health. Technical Paper Series. Inter-American Development Bank, Sustainable Development Department, Washington, DC.

    Google Scholar 

  • Melo, Marcus André. 1993. Anatomia do fracasso: Intermediação de interesses e a reforma das políticas sociais na Nova República. Dados Revista de Ciências Sociais 36(1): 119–164.

    Google Scholar 

  • ———. 2003. When institutions matter: A comparison of the politics of social security, administrative and tax reforms. In Reinventing leviathan: The politics of administrative reform in developing countries, ed. Ben Ross Schneider, 211–251. Miami: North South Center Press at the University of Miami.

    Google Scholar 

  • Melo, Marcus André. 2007a. Unexpected successes, unanticipated failures: Social policy from Cardoso to Lula. In Democratizing Brazil revisited, ed. Peter Kingston and Timothy Powers, 161–184. Pittsburgh: University of Pittsburgh Press.

    Google Scholar 

  • Melo, Marcus André. 2007b. Political competition can be positive: Embedding cash transfer programmes in Brazil. In Development Success: Statecraft in the South, ed. Anthony Bennington and William McCourt 30–51. London: Palgrave Macmillan.

    Google Scholar 

  • Melo, Marcus André, A. Leite, and E. Rocha. 2012. Competitive corruption: Evidence from randomized municipal audits in Brazil. Paper presented at the annual meeting of the American Political Science Association, New Orleans, 29 August–2 September.

    Google Scholar 

  • Melo, Marcus André, Armando Barrientos, and André Coelho. 2014. Taxation, redistribution and the social contract in Brazil, IRIBA Working Paper11, University of Manchester, UK.

    Google Scholar 

  • Menicucci, Telma M.G., and Jose Angelo Machado. 2010. Judicialization of health policy in the definition of access to public goods: Individual rights versus collective rights. Brazilian Political Science Review 4(1): 33–69.

    Google Scholar 

  • Mkandawire. T. 2005. Targeting and universalism in poverty reduction. Social policy and development programme Paper No. 23. Geneva: UNRISD.

    Google Scholar 

  • Mobarak, Ahmed, A.A. Rajkumar, and Maureen Cropper. 2011. The political economy of health services provision in Brazil. Economic Development and Cultural Change 59(4): 723–751.

    Article  Google Scholar 

  • Paim, Jairnilson, Claudia Travassos, Celia Almeida, Ligia Bahia, and James Macinko. 2011. The Brazilian health system: History, advances, and challenges. The Lancet 377(9779): 1778–1797. Also published as O sistema de saúde brasileiro: História, avanços e desafios. Série Saúde no Brasil 1. The Lancet 9 May: 11–31.

    Google Scholar 

  • Piola, Sérgio F., Andrea Barreto de Paiva, Edvaldo Batista de Sá, and Luciana Mendes Santos Servo. 2013. Financiamento público da saúde: Uma história à procura de rumo. Texto para discussão, 1846. Rio de Janeiro: IPEA.

    Google Scholar 

  • Rodin, J., and David de Ferranti. 2012. Universal health coverage: The third global health transition? The Lancet 380(9845): 861–862.

    Article  Google Scholar 

  • Rudra, Nita. 2007. Welfare states in developing countries: Unique or universal? Journal of Politics 69(2): 378–396.

    Article  Google Scholar 

  • Rudra, Nita, and Stephan Haggard. 2005. Globalization, democracy and ‘Effective’ welfare spending in the developing world. Comparative Political Studies 38(9): 1015–1049.

    Article  Google Scholar 

  • Savedoff, William D., David de Ferranti, Amy L. Smith, and Victoria Fan. 2012. Political and economic aspects of the transition to universal health coverage. The Lancet 380: 924–932.

    Article  Google Scholar 

  • Segura-Ubiergo, Alex. 2007. The political economy of the welfare state in Latin America: Globalization, democracy and development. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Skocpol, T. 1991. Targeting within universalism: Politically viable policies to combat poverty in the United States. In The urban underclass, ed. C. Jencks and P.E. Peterson, 411–436. Washington, DC: The Brookings Institution.

    Google Scholar 

  • Ter-minassian, Tereza. 2013. Improving social spending for a better life for all in Brazil. Vox LACEA. www.vox.lacea.org/?q=brazil_social_spending. Accessed 2 Mar 2016.

  • WHO (World Health Organization). 2010. World health report 2010: Health systems financing: The path to universal coverage. Geneva: WHO.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Recife, PE, Brazil

    Marcus André Melo

Authors
  1. Marcus André Melo
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. UNRISD, Geneva, Switzerland

    Ilcheong Yi

Copyright information

© 2017 United Nations Research Institute for Social Development

About this chapter

Cite this chapter

Melo, M.A. (2017). Political and Institutional Drivers of Social Security Universalization in Brazil. In: Yi, I. (eds) Towards Universal Health Care in Emerging Economies. Social Policy in a Development Context. Palgrave Macmillan, London. https://doi.org/10.1057/978-1-137-53377-7_6

Download citation

  • DOI: https://doi.org/10.1057/978-1-137-53377-7_6

  • Published:

  • Publisher Name: Palgrave Macmillan, London

  • Print ISBN: 978-1-137-53376-0

  • Online ISBN: 978-1-137-53377-7

  • eBook Packages: Economics and FinanceEconomics and Finance (R0)

Publish with us

Policies and ethics

Search

Navigation