The 1988 Brazilian Constitution, also called the “Citizen Constitution”, established universal access to health when, in its article 196, it stated that this is the right of all citizens and the Government’s responsibility. Just over a decade later, the Brazilian Unified Health System (SUS, Sistema Único de Saúde ) was created, which, in order to respect the principles of universality, integrality and equality established in the Magna Carta, laid down guidelines for decentralization, comprehensive care and popular participation.

Very much inspired at the time on the English health system, SUS is undoubtedly one of the largest public health systems worldwide, responsible for approximately 190 million people, 80% of whom depend exclusively on it to take care of their health, as they do not have access to the private health system. Still, even among those with access to the private system, the use of the public health system is constitutionally guaranteed, without limits or restrictions.

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Scrutinizing the quality of the Brazilian health system

Since the Brazilian 1998 Federal Constitution (Constitution of the Citizen) was signed and the Brazilian National Unified Health Care System (SUS) was created in 1990, the right to integral, universal, equalitarian and free access to health services of quality has been granted to all Brazilians. The State would have to finance, provide and operate the infrastructure necessary to fulfill the Law 8.080/1990. The constitutional recognition that health is a universal right was a substantial ideological advance. On paper, the public health model idealized for Brazil has become an example to the world. Approximately 75% of Brazilians are estimated to depend on the SUS for health care, while the remaining Brazilians have private complementary coverage.

If the objective is to generate relevant information to guide decision making regarding public policies on health, we should systematically dedicate ourselves to scientifically assess the health care outcomes of SUS. However, after 25 years from SUS implantation, there is little scientific evidence, especially that representing the continental country Brazil is, on the final health care outcomes of SUS. For example, representative data on post-acute myocardial infarction mortality, reperfusion treatment rate or hospital readmission rate in 30 days are not available. Moreover, little is known about the disparities of the health care outcomes between the SUS and the private health care system.

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