Obstacles to sus universalization: Tax expenditures, labor union demands and health insurance state subsidy

Abstract

In the light of the comparative analysis of health systems, we discuss three strategic phe-nomena for the SUS universalization, as follows: a) health tax expenditures; b) State funding of private plans for public servants; and c) trade union’s demand for private health plans. Among the ideal types of health systems, SUS is universal in law, but hybrid in practice: Beveridgian in primary health care (PHC) and mixed in specialized/hos-pital care; without really being universal (public spending is only 43% of total health expenditure). There is a massive state subsidy to the private sec-tor, through health tax expenditures (30% of the federal health budget) and financing of private plans for public servants, which generates incoher-ence, segmentation of the health system and ineq-uities. Despite the general support to the SUS, the union movements have been using private health plans in collective recruitment (76% of them), re-inforcing the private sector. Reducing health tax expenditures-including state funding of servants’ private plans-would significantly increase the SUS budget and facilitate articulation between health workers and trade unionists, bringing the high strength of unions closer to the long struggle for the universality of the SUS and PHC.