INTRODUCTION – Universal health coverage (UHC) is today at the forefront of the worldwide public health debate. This represents the confluence of an ethical perspective which espouses the right to health as a human right (Rumbold et al., 2017) and an efficiency perspective which recognizes the growing evidence that health contributes to human capital accumulation and productivity growth (Almond and Currie, 2011; Dupas and Miguel, 2017). Both the World Health Organization and the World Bank have recently endorsed UHC, and called on the global community to universalize access to affordable health care within a generation (WHO and World Bank, 2017; Bloom et al., 2018). This movement has also reached the policy world, with several developing countries in Africa, Asia, and Latin America trying to expand access to health care (Boerma et al., 2014; Atun et al., 2015; Reich et al., 2016), and with Obamacare becoming one of the key domestic policy debates in the US over the last decade (Cotlear et al., 2015; Reinhardt, 2017).
This paper investigates the universalization of access to health in Brazil, a country that is considered a forerunner by the public health community and a potential model for other developing and developed societies (Harris, 2014; Atun et al., 2015). The Brazilian 1988 Constitution established universal and egalitarian access to health care as a constitutional right. Legislation instituted in the following years created the present Brazilian public health system, called the Unified Health System (SUS, for Sistema Único de Saúde).