New England Journal of Medicine
June 4, 2015 Vol. 372 No. 23
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
International Health Care Systems
Brazil’s Family Health Strategy — Delivering Community-Based Primary Care in a Universal Health System
James Macinko, Ph.D., and Matthew J. Harris, M.B., B.S., D.Phil.
N Engl J Med 2015; 372:2177-218 1June 4, 2015 DOI: 10.1056/NEJMp1501140
[Initial text]
Brazil has made rapid progress toward universal coverage of its population through its national health system, the Sistema Único de Saúde (SUS). Since its emergence from dictatorship in 1985, Brazil — which has the world’s fifth-largest population and seventh-largest economy — has invested substantially in expanding access to health care for all citizens, a goal that is implicit in the Brazilian constitution and the principles guiding the national health system.1 The SUS comprises public and private health care institutions and providers, financed primarily through taxes with contributions from federal, state, and municipal budgets. Health care management is decentralized, and municipalities are responsible for most primary care services as well as some hospitals and other facilities. All publicly financed health services and most common medications are universally accessible and free of charge at the point of service for all citizens — even the 26% of the population enrolled in private health plans (see table)
An important innovation in the system has been the development, adaptation, and rapid scaling up of a community-based approach to providing primary health care…