Cobertura Universal de Saúde e o Brasil: estamos no bom caminho?

Abstract

THE WORLD HEALTH ORGANIZATION (WHO), by issuing the Universal Health Coverage slogan in its 2010 1 report, stating that it was the "most powerful concept that public health could offer", caused great controversy. Firstly, because both the Universal Declaration of Human Rights and the WHO Statutes enshrined as powerful and essential the right of all to health. Secondly, because the 30th World Health Assembly of 1977 2 had renewed the commitment by launching the Health for All slogan in 2000, preceding the famous Alma-Ata Primary Health Care Conference held in 1978. Thirdly, because it produced a semiotic dystopia when resignifying the concept of 'coverage' of services traditionally employed in health, depriving it of the essential attributes of access and use 3 . Fourth, because it also dissociated from the concept of 'universality', relevant ancillary attributes of equity and justice. Fifth, because it posed as its starting point the issue of the mode of financing of benefits, in particular the issue (relevant but improperly appropriated) of catastrophic personal spending resulting from expenditure on health services. Sixth, because the WHO set aside the important report on the Social Determinants of Health 4 , finished two years earlier, limiting health to service provision.A serious researcher from the World Bank, in an article published on his blog at the time, when wondering if the case was that of 'old wine in a new bottle', sought to identify what the proposal brought as novelty 5 . He warned that, in order to be useful, it was necessary to add the dimensions of equity, associating the obtaining of care to its need, not to the ability to pay for it. He added that it was necessary to ensure coverage 'de facto' (i.e. access and use), and not simply 'de jure' ('on paper') and the quality of the services provided.It was not long before one discovered where the heart of dystopia lied. It was essentially about securing the 'de jure' coverage and a curious package (pooling) of funds to 'protect' people from 'catastrophic spending' on health services. However, such expenses only occurred and still occur due to the private provision of health services, including medicines and other supplies which, in the absence of public services, are charged from patients and their families. Wrong diagnosis, wrong therapy. If services are charged by individuals, rather than organizing free public services, they propose pooling resources to compensate providers. However, this pooling must be obtained through specific charges, either by private intermediaries (health insurances) or by additional specific taxation other than the taxes, contributions, and fees that governments employ for their provisions.This eliminates the need to build universal health systems that guarantee 'de facto' equity and coverage and that ensure access to and use of quality health services according to the needs of each individual. In fact, the creation and expansion of specific private or public