1 Fundação Oswaldo Cruz - IAM, Recife, Brazil.
2 Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Int J Health Serv. 2017 Oct;47(4):690-702. doi: 10.1177/0020731417732543. Epub 2017 Sep 29.
In 1990 the national health services in the United Kingdom and Sweden started to split up in internal markets with purchasers and providers. It was also the year when Brazil started to implement a national health service (SUS) inspired by the British national health service that aimed at principles of universality, equity, and integrality. While the reform in Brazil aimed at improving equity and effectiveness, reforms in Europe aimed at improving efficiency in order to contain costs. The European reforms increased supply and utilization but never provided the large increase in efficiency that was hoped for, and inequities have increased. The health sector reform in Brazil, on the other hand, contributed to great improvements in population health but never succeeded in changing the fact that more than half of health care spending was private. Demographic and epidemiological changes, with more elderly people having chronic disorders and very unequal comorbidities, bring the issue of integrality in the forefront in all 3 countries, and neither the public purchaser provider markets nor the 2-tier system in Brazil delivers on that front. It will demand political leadership and strategic planning with population responsibility to deal with such challenges.
1990 年，英国和瑞典的国家卫生服务开始在内部市场中进行分割，设立了购买方和供应方。也是在这一年，巴西开始实施一项国家卫生服务体系（SUS），该体系受到英国国家卫生服务体系的启发，旨在实现普遍性、公平性和完整性原则。尽管巴西的改革旨在提高公平性和效率，但欧洲的改革旨在提高效率以控制成本。欧洲的改革增加了供应和利用，但从未提供预期的效率大幅提高，而且不平等现象有所增加。另一方面，巴西的卫生部门改革极大地改善了人口健康状况，但从未成功改变超过一半的医疗保健支出是私人支付的事实。人口和流行病学的变化，加上更多的老年人患有慢性疾病和非常不平等的合并症，使得所有 3 个国家都面临着完整性的问题，公共购买方-供应方市场和巴西的双层体系都无法解决这一问题。这将需要有责任感的人口的政治领导和战略规划来应对这些挑战。
