Los altos costos de la atención de salud en el Brasil / The high cost of health care in Brazil

RESUMO

An analysis is presented of the changes that have occurred in Brazilian health sector expenditures in recent years, and of the factors that have favored the excessive growth of curative care at the expense of health promotion- in particular, the balance between the public and the private sector, and the role the public financing, and foreign médical technology, among others. The analysis focuses on the médical-hospital system in Brazil, given its importance as an essential supplier of health services, and on the National Institute of Medical Care and Social Welfare (INAMPS), the agency that under writes the major portion of médical and hospital expenditures. The first section outlines the general features of the fee system that was adopted by the INAMPS for payments to health service suppliers, as well as the basic standards that govern the work of this agency in the context of the Brazilian health system. Notable in this regard are the policy changes adopted in the early 1980s with a view to reducing costs. The second section examines the high cost of Brazilian health care with a discussion of the following topics the role of the physicians, the INAMPS fee schedule, high technology in medicine, behavior and health costs, choice of services, excessive rates of cesárean deliveries, and physicians and the choice of technology. One of the principal conclusions is that the cost of health care is