Brazil's multiple social insurance programs and their influence on medical care

The historical evolution of social insurance and medical care in Brazil is outlined in this paper. A description is given of the gradual expansion of the direct provision of medical services by the social security institutions between 1933 and 1955, after which there was a leveling off period and then a decrease in services in relation to the growth of the number of persons covered. Social insurance now provides barely ten per cent of the medical services used by the beneficiaries; contracts with separate hospitals and doctors account for the rest. Although social insurance has not succeeded in modifying completely the patterns of medical care in Brazil, it has contributed, together with other government activities in the health sector, to a substantial modification of the patterns that existed before the introduction of social insurance. This change has been most noticeable in hospital care, since social insurance has become the single largest financing agency of Brazilian hospitals.