UHS development and hospital services rationing

We analyze the Brazilian health care system from a comparative perspective. The migration of middle income clienteles to private prepaid companies brings the Brazilian case close to the American one. The production of hospital services in the UHS demonstrates an important reduction in supply aggravated by population growth and by expectations defined by constitutional provisions. The reduction is selective, being concentrated in obstetric and medical clinic services and for-profit private services. In order to ensure equitable access it is necessary to: amplify public expenditure; reduce expenditure from out-of-pocket payments; organizational reforms; amplification of government capacity.