Universal health care: For whom?

The discussion toward on how to guarantee a just health public system presented in this paper rely on the Brazilian public health system experience. It is known that the public institutions and policies are crucial to decrease inequalities in health and the social inequalities behind them. The main definition of health in “SUS” (Sistema Único de Saúde), the Brazilian health public system, is that health is a universal right that seeks the well-being and which provision is responsibility of the state and of each citizen, what, at least theoretically, means that all Brazilian citizen has the right to be healthy and have access to public healthcare and social services, mainly the ones whose have an important impact on populations health. The main point is that the reality is far from this definition, on one hand, the public system has low quality and is for the majority of the population, and on the other hand, only the minority has access to health services of high quality offered for both, by the market and even by the public services (when high complexity healthcare is necessary).

By considering the real-word challenges faced for the Brazilian society and the design of public Brazilian institutions that impact on population health, this paper intend to provide the discussion towards how to get a just public healthcare system from empirical and theoretical elements that allows the understanding of the actual problems to implement the system proposal and how the relation between the public and the market aims has influence on the system results.

The approach here considers that the understand of health must rely on a broad concept concerned with the social determinants and the socioeconomic gradient of health, since health is thought as a good of a moral importance, essential for a just society.