Challenges to the Universalization of Brazil’s Unified Health System: The Internal Expansion of the Private Sector within the Public System
1
1. Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo, Vitória, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Brazil has a Unified Health System (Sistema Único de Saúde – SUS), and more than 76% of the population rely on it exclusively¹,². To this end, the 1988 Federal Constitution (CF/88) guaranteed free private initiative and allowed private institutions to be linked to the SUS². Through state incentives, different private sectors expanded both prior to and following the enactment of CF/88³. Thus, the aim of this study is to demonstrate the forms of private sector participation within the SUS.
METHODS:
Documentary research conducted through data collection from federal government portals, combined with the theoretical framework of critical political economy.
RESULTS:
The legacy of the private sector’s relationship with the Brazilian State unfolded at the beginning of the SUS, with more than 70% of contracts originating from the private sector4, a logic encouraged through: Autarchies, CF/88: autonomous public-law entities². Public foundations, Decree No. 7,596/1987: private-law entities, non-profit, public or private⁵. Public consortia, Law No. 11,107/2005: private-law entities to manage services, works, and activities⁶. Public enterprises, Law No. 8,945 and Decree No. 8,945/2016: private-law entities with the majority of capital originating from public sources⁷,⁸. Autonomous social services, CF/88: private entities providing social services and professional training linked to the trade union system². Social organizations, Law No. 9,637/1998: status granted to private non-profit institutions for service management⁹,¹⁰. Civil Society Organizations of Public Interest (OSCIP), Law No. 9,790/1999: private non-profit entities¹¹. Support foundations, Decree No. 7,423/2010: created to support research, teaching, and extension projects¹². Public–Private Partnerships (PPP), Law No. 11,079/2004: private institutions linked to the government through partnerships¹³. Such extensive philanthropic participation accounts for nearly half of all procedures within the SUS¹⁴.
CONCLUSIONS:
The discourse of efficiency has legitimized the growth of the private sector, and after 30 years of the health reform, Brazil has been called upon to rethink this logic.
Brazil has a Unified Health System (Sistema Único de Saúde – SUS), and more than 76% of the population rely on it exclusively¹,². To this end, the 1988 Federal Constitution (CF/88) guaranteed free private initiative and allowed private institutions to be linked to the SUS². Through state incentives, different private sectors expanded both prior to and following the enactment of CF/88³. Thus, the aim of this study is to demonstrate the forms of private sector participation within the SUS.
METHODS:
Documentary research conducted through data collection from federal government portals, combined with the theoretical framework of critical political economy.
RESULTS:
The legacy of the private sector’s relationship with the Brazilian State unfolded at the beginning of the SUS, with more than 70% of contracts originating from the private sector4, a logic encouraged through: Autarchies, CF/88: autonomous public-law entities². Public foundations, Decree No. 7,596/1987: private-law entities, non-profit, public or private⁵. Public consortia, Law No. 11,107/2005: private-law entities to manage services, works, and activities⁶. Public enterprises, Law No. 8,945 and Decree No. 8,945/2016: private-law entities with the majority of capital originating from public sources⁷,⁸. Autonomous social services, CF/88: private entities providing social services and professional training linked to the trade union system². Social organizations, Law No. 9,637/1998: status granted to private non-profit institutions for service management⁹,¹⁰. Civil Society Organizations of Public Interest (OSCIP), Law No. 9,790/1999: private non-profit entities¹¹. Support foundations, Decree No. 7,423/2010: created to support research, teaching, and extension projects¹². Public–Private Partnerships (PPP), Law No. 11,079/2004: private institutions linked to the government through partnerships¹³. Such extensive philanthropic participation accounts for nearly half of all procedures within the SUS¹⁴.
CONCLUSIONS:
The discourse of efficiency has legitimized the growth of the private sector, and after 30 years of the health reform, Brazil has been called upon to rethink this logic.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
