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.
DesaiMNolteEKaranikolosMKhoshabaBMcKeeM. Measuring NHS performance 1990-2009 using amenable mortality: interpret with care. J R Soc Med2011; 104(9): 370–379.
6.
LimaNTGerschmanSEdlerFCSuárezJM. Saúde e Democracia. História e perspectivas do SUS, Rio de Janairo, Brazil: Fundação Oswaldo Cruz/Editora, 2006.
7.
LimaLD. Conexões entre o federalismo fiscal e o financiamento da política de saúde no Brasil. Ciência & Saùde Coletiva2007; 12(2): 511–522.
8.
HamC. Reforming the Swedish health services: the international context. Health Pol1992; 21(2): 129–141.
9.
MaynardA. Can competition enhance efficiency in health care? Lessons from the reform of the U.K. national health service. Soc Sci Med1994; 39: 1438–1445.
10.
PaimJSTravassosCAlmeidaCBahiaLMacinkoJ. The Brazilian health system: history, advances and challenges. Lancet2011; 377: 1778–1797.
11.
BerlinguerGTeixeiraSMHCamposGWS. Reforma Sanitaria: Italia e Brasil, Sao Paulo, Brazil: HUCITEC/CEBES, 1988.
RizottoMLFCamposGWS. The World Bank and the Brazilian National Health System in the beginning of the 21st century. Saúde Soc. Sao Paulo2016; 25(2): 263–276.
14.
MendesAMarquesRM. O financiamento da Atenção Básica e da Estratégia Saúde da Família no Sistema Único de Saúde. Saúde Debate2014; 38(103): 900–916.
15.
Cruz SA, Vieira-da-Silva LM, Costa MCN, Paim JS. Evolution of inequalities in mortality in Salvador, Bahia State, Brazil 1991/2006. Cad.Saude Pública, Rio de Janeiro. 2011;27 (Suppl 2):S176–S184.
16.
FrançaGVARestrepo-MéndezMCMaiaMFSMVictoraCGBarrosAJD. Coverage and equity in reproductive and maternal health interventions in Brazil: impressive progress following the implementation of the Unified Health System. Int J Equity Health2016; 15(1): 149.
Institute for Health Metrics and Evaluation (IHME). Compare data visualization. Seattle, WA: University of Washington; 2016. http://vizhub.healthdata.org/gbd-compare. Accessed June 7, 2017.
MendesA. A saúde pública brasileira no contexto da crise do Estado ou do capitalismo?Saúde Soc São Paulo2015; 24(Suppl 1): 66–81.
22.
EliasPEMCohnA. Health reform in Brazil: lessons to consider. Am J Publ Health2003; 93(1): 44–48.
23.
GerschmanS. Public and private health insurance in Brazil and European union countries. Am J Publ Health Res2013; 1(4): 78–85.
24.
MacinkoJLima-CostaMF. Horizontal equity in health care utilization in Brazil, 1998–2008. Int J Equity Health2012; 11: 33.
25.
MullacheryPSilverDMacinkoJ. Changes in health care equity in Brazil between 2008 and 2013. Int J Equity Health2016; 15: 140.
26.
FerrazOLM. The right to health in the courts of Brazil: worsening health inequities?Health Hum Right J2009; 11(2): 33–45.
27.
HarrisonMCalltorpJ. The reorientation of market-oriented reforms in Swedish health care. Health Pol2000; 50: 219–240.
28.
SaltmanRBBergmanSE. Renovating the common: Swedish Health Care Reforms in perspective. J Health Polit Pol Law2005; 30(1–2): 253–275.
29.
HartJT. The Political Economy of Health Care, 2nd ed. Bristol, England: Policy Press, 2010.
30.
DiderichsenF. Market reforms in health care and sustainability of the welfare state: lessons from Sweden. Health Pol1995; 32(1–3): 141–153.
31.
DahlgrenG. Neoliberal reforms in Swedish primary health care—for whom and for what purpose. Int J Health Serv2008; 38(4): 697–715.
32.
Working for patients. NHS White Paper. New diagnosis—new perspectives. Health Serv J1989; 99(5136): 134–137.
33.
HamCAlderwickH. A way forward for the NHS. Take a place-based approach to care. Health Serv J2015; 125: 16–17.
34.
IsakssonDBlomqvistPWinbladU. Free establishment of primary health care providers: effects on geographical equity. BMC Health Serv Res2016; 16: 28.
35.
DahlgrenG. Why public health services? Experiences from profit-driven health care reforms in Sweden. Int J Health Serv2014; 44(3): 507–524.
36.
AnellA. The public-private pendulum—patient choice and equity in Sweden. N Engl J Med20151, 372, 1–4.
37.
BurströmBBurströmKNilssonGThomsonGWhiteheadMWinbladU. Equity aspects of the primary health care choice reform in Sweden: a scoping review. Int J Equity Health2017; 16(1): 29.
