Access to Healthcare: A Central Question within Brazilian Bioethics

Abstract

This article explores the current situation regarding the importance of access to healthcare in relation to the genesis and context of bioethics developed in Brazil, a country in which healthcare is understood through the national constitution to be a universal right of its population. Since the onset of the development of Brazilian bioethics at the beginning of the 1990s, topics relating directly and indirectly to the field of public health have been a priority in the bioethics agenda. The article considers the socioeconomic context within which conflicts occur, an issue that has been addressed in other scientific articles on bioethics in Latin America. It presents the main conceptual bases of intervention bioethics, a critical approach that has been developed as a reference point in this region, with the aim of analyzing (bio)ethical issues and indicating solutions that relate specifically to the different forms of social exclusion that influence the health conditions and lives of people in Brazil, as well as in other peripheral countries in the Southern Hemisphere and of the world in general. The article calls attention to some of the problems and challenges that the Brazilian public health system has been facing. An international agenda of "universal health coverage" is one of the main global threats to implementing the universal right to healthcare as it has been understood in Brazil.

Dengue Surveillance System in Brazil: A Qualitative Study in the Federal District

“…According to our analysis, the main problems for the surveillance system occur when, due to lack of resources, the public healthcare system fails to meet the needs of the population, rather than being caused by a failure of the surveillance system itself. The need for greater public health investment is corroborated by the existing literature, which suggests that public underfunding hinders the access to public healthcare and its effectiveness [32,33]. Investments in public healthcare and surveillance and the provision of enough human and technological resources might accelerate the surveillance processes.…”

“…Private sector underreporting is particularly relevant as Brazilian healthcare relies on a growing number of private-public partnerships, and private healthcare is growing [32]. The lack of resources impedes the access to public healthcare [33,34], and the perceived quality of service is higher in the private sector. This influences Brazilian's health seeking behavior, even in poor urban settings [35].…”

Strengthening health systems to achieve Universal Health Coverage: Lessons from four Latin American countries.

“…Guided by ve core principles (universality, integrality, equity, decentralization, and social participation), the creation of the SUS in 1988 has been cited as "the most in uential movement toward social inclusion and democratization in health." [32,33] SUS provides access to free health services through programs, such as Estrategia de Saúde Familiar [Family Health Strategy] (ESF), a community-based, multidisciplinary program that assists vulnerable populations, by engaging community healthcare workers within the PHC delivery chain. [15,17,33] ESF is one of the biggest community-based PHC programs in the world [15], achieving higher quality of care and user-satisfaction than traditional primary or private health care.…”

“…[32,33] SUS provides access to free health services through programs, such as Estrategia de Saúde Familiar [Family Health Strategy] (ESF), a community-based, multidisciplinary program that assists vulnerable populations, by engaging community healthcare workers within the PHC delivery chain. [15,17,33] ESF is one of the biggest community-based PHC programs in the world [15], achieving higher quality of care and user-satisfaction than traditional primary or private health care. [17] After expanding coverage of marginalized populations [15], ESF reduced mortality from both non-communicable and infectious diseases, especially infant mortality due to diarrhea and respiratory infections, while improving health outcomes for people living in remote areas.…”

“…[16,29] In Brazil, both public and private providers may deliver primary care, vaccination, pharmaceutical coverage, dental care, and tertiary care, while private organizations provide the most advanced medical care. [28,33] PPP improves access to primary services at many municipalities. [46] However, signi cant controversy surrounding the recent introduction of foreign insurance companies and healthcare providers [33] to the market and the indiscriminate, not outcome-based payments for these organizations.…”