Challenges and perspectives of public health in Brazil

an analysis of the Unified Health System (SUS)

Abstract

This article examines the complex dynamics of public health financing in Brazil, focusing on the impact of Constitutional Amendment No. 95/2016 (Spending Cap), the distribution of resources among federal entities, and the new funding model for Primary Health Care. It begins by recognizing that the Unified Health System (SUS), established by the 1988 Federal Constitution, represents a milestone in ensuring the universal right to health, guided by the principles of universality, integrality, and equity. However, the gradual reduction of public investment and the fiscal restrictions imposed by EC 95 have compromised the system’s ability to expand and maintain essential health policies, worsening regional inequalities and limiting equitable access to healthcare services. The study also explores Brazilian fiscal federalism, emphasizing how the concentration of financial resources in the federal government and the dependency of states and municipalities contribute to significant disparities in healthcare provision, particularly in poorer and peripheral regions. Furthermore, it analyzes the reformulation of Primary Health Care funding through the Previne Brasil program, which redefined transfer criteria by prioritizing performance indicators and population registration over universal coverage. While aiming for efficiency and measurable outcomes, this model has raised concerns about the exclusion of vulnerable populations and the discontinuity of preventive and community health actions. The article concludes that strengthening the SUS requires revising the current fiscal model, increasing public investments, and adopting integrated and equitable management strategies to ensure the financial sustainability and effectiveness of Brazil’s public health policies.