Public/Private Mix in the Brazilian Health System and the Quest for Equity

The paper discusses the intricate relationship between the public and the private sectors in the current configuration of the Brazilian health system. Although not foreseen in the universal and public model created by the 1988 Constitution, this setting has been consolidated, making it challenging and politically difficult to change. Its expression is a fragile regulation of the private sector, the expansion of private participation in the provision of services, especially in human resources, and the reduction of public funding. In this account, we analyze the Brazilian health system and the political and institutional settings that contributed to the public-private mix and the conflicts it generates. We conclude that Brazil is characterized by a unique process where public and private systems grow together and in conjunction with one another. Such a mix may compromise the equity objectives of universalizing equal access to quality of care for all of Brazil's population.