Health sector reform in Brazil: A case study of inequity

Health sector reform in Brazil built the Unified Health System according to a dense body of administrative instruments for organizing decentralized se rvice networks and institutionalizing a complex decision-making arena. This article focuses on the equity in health care services. Equity is defined a s a principle governing distributive functions designed to reduce or offset socially unjust inequalities, and it is applied to evaluate the distributi on of financial resources and the use of health services. Even though in th e Constitution the term "equity" refers to equal opportunity of access for equal needs, the implemented policies have not guaranteed these rights. Und erfunding, fiscal stress, and lack of priorities for the sector have contri buted to a progressive deterioration of health care services, with continui ng regressive tax collection and unequal distribution of financial resource s among regions. The data suggest that despite regulatory measures to incre ase efficiency and reduce inequalities, delivery of health care services re mains extremely unequal across the country. People in lower income groups e xperience more difficulties in getting access to health services. Utilizati on rates vary greatly by type of service among income groups, positions in the labor market, and levels of education.