LEADER 04685nam 2200721Ia 450 001 9910971188703321 005 20200520144314.0 010 $a9780821399323 010 $a0821399322 024 7 $a10.1596/978-0-8213-9843-2 035 $a(CKB)2550000001100295 035 $a(OCoLC)857076888 035 $a(CaPaEBR)ebrary10731996 035 $a(SSID)ssj0000917176 035 $a(PQKBManifestationID)11576127 035 $a(PQKBTitleCode)TC0000917176 035 $a(PQKBWorkID)10878250 035 $a(PQKB)11706037 035 $a(MiAaPQ)EBC1316477 035 $a(Au-PeEL)EBL1316477 035 $a(CaPaEBR)ebr10731996 035 $a(CaONFJC)MIL504721 035 $a(OCoLC)853548999 035 $a(DNLM)101609520 035 $a(US-djbf)17762529 035 $a(Perlego)1484307 035 $a(EXLCZ)992550000001100295 100 $a20130603d2013 uy 0 101 0 $aeng 135 $aurcn||||||||| 181 $2rdacontent 182 $2rdamedia 183 $2rdacarrier 200 10$aTwenty years of health system reform in Brazil $ean assessment of the Sistema Un?ico de Saud?e /$fMichele Gragnolati, Magnus Lindelow, Bernard Couttolenc 205 $a1st ed. 210 $aWashington, D. C. $cWorld Bank$d2013 215 $a1 online resource (pages cm) 300 $aBibliographic Level Mode of Issuance: Monograph 311 08$a9780821398432 311 08$a0821398431 311 08$a9781299734708 311 08$a1299734707 320 $aIncludes bibliographical references and index. 327 $aHave the SUS reforms transformed the Brazilian health system? -- Have the SUS reforms led to better outcomes?. 330 $aIt has been over twenty years since the Brazilian Sistema Único de Saúde (Unified Health System or SUS) was formally established by the 1988 Constitution. The impetus for the SUS came in part from rising costs and a crisis in the social security system that preceded the reforms, but also from a broad-based political movement calling for democratization and improved social rights. Building on reforms that started in the 1980s, the SUS was based on three overarching principles: (i) universal access to health services, with health defined as a citizen’s right and an obligation of the state; (ii) equality of access to health care; and (iii) integrality (comprehensiveness) and continuity of care; along with several other guiding ideas, including decentralization, increased participation, and evidence-based prioritization. The SUS reform established health a fundamental right and duty of the state, and started a process of fundamentally transforming Brazil’s health system to achieve this goal. So, what has been achieved since the SUS was established? And what challenges remain in achieving the goals that were established in 1988? These questions are the focus of this report. Specifically, it seeks to assess whether the SUS reforms have managed to transform the health system as envisaged more than 20 years ago, and whether the reforms have led to improved outcomes in terms of access to services, financial protection, and health status.Any effort to assess the performance of a health system runs into a host of challenges concerning the definition of boundaries of the "health system", the outcomes that the assessment should focus on, data sources and quality, and the role of policies and reforms in understanding how the performance of the health system has changed over time. Building on an extensive literature on health system assessment, this report is 330 8 $abased on a simple framework that specifies a set of health system "building blocks", which affect a number of intermediate outcomes such as access, quality and efficiency, which, in turn, contribute to final outcomes, including health status, financial protection, and satisfaction. Based on this framework, the report starts by looking at how key building blocks of Brazil’s health system have changed over time and then moves on to review performance in terms of intermediate and final outcomes. 410 0$aWorld Bank e-Library. 606 $aPublic health administration$zBrazil 606 $aHealth care reform$zBrazil 615 0$aPublic health administration 615 0$aHealth care reform 676 $a362.10981 700 $aGragnolati$b Michele$f1968-$01811170 701 $aLindelow$b Magnus$01811411 701 $aCouttolenc$b Bernard$01805155 712 02$aWorld Bank. 801 0$bMiAaPQ 801 1$bMiAaPQ 801 2$bMiAaPQ 906 $aBOOK 912 $a9910971188703321 996 $aTwenty years of health system reform in Brazil$94363276 997 $aUNINA