Brazilian public and private health systems: Differences, similarities and lessons learned

Background: Brazilian Constitution states universal access to public health assistance, although allows the existence of a private supplementary health system, which currently assists over 40 million beneficiaries (over 21% of the population). Quality and access differentiation compared to the public system are marketed by private health plans attracting customers to a market that grew beneficiaries at 4.5% CAG, compared to a 1.4% CAG population growth for the last 4 years. Although a deeper analysis of both systems’ characteristics indicate strong similarities between them. Objective: Analyze benchmarking practices adopted by both systems which reduce differentiation although tend to improve operation. Methods: Qualitative study conducted by open-ended interviews with main actors of the Supplementary Health Chamber of the National Supplementary Health Agency (ANS), where the majority of the health market actors are represented. Results: Additional product coverage and financial guarantee requirements demanded by the supplementary health regulation have successively increased since 1998, affected private health plan companies' financial results, conducting them to seek for cost optimization opportunities like the adoption of health prevention and promotion practices as chronic disease management and at the same time controlling service access via a hierarchyzed organization as established for the public system. On the other hand budget limitations on the public system have stimulated adoption of performance indicators and cost controls utilized by the private sector as well as the offering by several public and university hospitals of differentiated paid services, comparable to private health system products. Conclusions: The cross-fertilization between public and private systems practices reduces their differentiation, challenging the logic of their coexistence, the price justification of the private health plans and the government’s capability to maintain universality and equity which are basic principles of the public system.