Private Owned Highways and Government Owned Health System, does that make sense?

by Luiz Castro | July 3, 2008 at 10:16 am | 326 views | 8 comments

Non government public companies managing highway systems in Brazil are not something exactly that we can call new. It has been like that for more than 20 years now, but the idea is expanding.

Brazil is privatizing most of its highway system in a concession plan. Different companies are biding for highways and they will be responsible for maintenance and system expansion for up to 25 years. The system establishes a maximum amount charge for tollbooths and has proved very successful.

Brazil also have a public health system, called SUS - Sistema Unico de Saude ( Unified Health Care System) that is government managed and is responsible for free health care for most of the national population. Private health insurance also exists and is available for those who are able to pay.

The public system is still grossly underfunded and lacking quality, though that's been improving greatly in the last few years.

My reflection point is: Why The United States can afford a government owned highway system, very expensive, and can't afford a universal heath care system?

That is a poising question for this Presidential campaign times.

Brazil's national development bank BNDES suggested a maximum toll of 3.15 reais (US$1.95) for concessions on 667km of Bahia state's BR-116 and BR-324 highways, the bank announced in a statement.

The concession will be awarded to the firm or consortium that presents the lowest toll rate.

The draft of the bidding rules was presented in a public hearing on June 16 by national ground transportation agency ANTT. BNDES carried out the financial studies for the process.

The draft stipulates that the bid winner will install five toll booths on the BR-116 highway and two on the BR-324 stretch.

The winner is expected to invest 2bn reais on the two highways during the 25-year concession.

Brazilian health system is composed of a large public, government managed system, the SUS (Sistema Único de Saúde) , which serves the majority of the population, and a private sector, managed by health insurance funds and private entrepreneurs.
The public health system, SUS, was established in 1988 by the Brazilian Constitution, and sits on 3 basic principles of universality, comprehensiveness and equity. Universality states that all citizens must have access to health care services, without any form of discrimination, regarding skin color, income, social status, gender or any other variable. Comprehensiveness(integralidade) states that citizen's health is the result of multiple variables, including employment, income, access to land, sanitation services, access and quality of health services, education, psychic, social and family conditions, and are entitled to full and complete health care, comprising prevention, treatment and rehabilitation. Equity states that health policies should be oriented towards the reduction of inequalities between population groups and individuals, being the most needed the ones for whom policies should be first directed. SUS has also guidelines for its implementation, the most peculiar being popular participation, which defines that all policies are to be planned and supervised directly by the population, through local, city, state and national health councils en conferences. This is regarded as a very advanced form of direct democracy and has established the guidelines for many similar initiatives in sectors other than health all over Brazilian society.
The public system is still grossly underfunded and lacking quality, though that's been improving greatly in the last few years. Important legal issues, such as the regulation of Constitutional Amendment 29, are expected to minimize some of those problems.
Private Health Insurance is widely available in Brazil and may be purchased on an individual-basis or obtained as a work benefit (major employers usually offer private health insurance benefits). Public health care is still accessible for those who choose to obtain private health insurance. As of March, 2007, more than 37 million Brazilians had some sort of private health insurance

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julianw

at 10:27 on July 3rd, 2008

good stuff:

lfcastro, I like this story. I'm interested in the politics surrounding Brazil's public health care system. Is the health system seen as the creation of left-leaning politicians? Is it supported by a wide range of interest groups?

Luiz Castro

at 17:13 on July 3rd, 2008

No, in reality Brazil always had a public health system. Under the 1988 Constitution, the changes were related with the system management. Before that Brazil had Federal, State and Municipal systems. After 1988 they unified all them into the SUS and that is managed by the cities. The system is largely funded by the Federal Government and States, but the administration is local. That has created a better system but some discrepancies also. We have cities with great health care and others not so great The actual leftist administration is not responsible for the creation of the system, but has made some efforts on improving that. The entire system is improving so far, but it is still a "long highway" to get there.