Imagine the following scene: João, a Brazilian from the outskirts of São Paulo, has been dealing with persistent chest pain for weeks. The fear of endless lines and uncertainty about being treated at the public health clinic makes him postpone his visit to the doctor. On the other side of the world, in Seoul, Ji-hyun, a South Korean worker, easily books her appointment online and goes to the clinic on the same day. While Ji-hyun sees the doctor around 16 times a year, João, like most Brazilians, consults a healthcare professional only twice a year.
This disparity is no coincidence. Behind these differences lies a complex mosaic of public policies, economic structures, and social inequalities. Today, we’ll analyze what countries like South Korea can teach us and how Brazil can transform its healthcare reality.
Two Worlds, Two Systems
What makes South Korea a global example? To begin with, the country adopts a "fee-for-service" model, where doctors are remunerated based on the number of consultations performed. This system, combined with a universal health insurance policy that covers more than 70% of medical costs, creates an environment that encourages people to seek frequent care.
In Brazil, however, the situation is different. The SUS (Unified Health System), a national pride for guaranteeing universal access, faces challenges that limit its effectiveness. Resource scarcity, long waiting lines, and regional inequalities often deter patients like João from seeking regular medical care. Meanwhile, around 25% of the Brazilian population turns to the private system, which, although faster, struggles with escalating costs and has faced sustainability issues since the COVID-19 pandemic.
The Weight of Inequality
How often someone visits the doctor is deeply linked to their income. Studies show that wealthier individuals in Brazil have greater access to medical consultations, even when their healthcare needs are similar to those of lower-income groups. This gap reflects the structural inequality that permeates the country, worsening in poorer and more remote regions.
In South Korea, public policies minimize these barriers. With a homogeneous system, citizens, regardless of their social class, have similar access to medical consultations. This balance is something Brazil can aspire to as it shapes its healthcare policies.
Lessons from Other Countries
South Korea is not the only example of how to improve access to healthcare. Let’s explore some inspiring approaches:
Telemedicine and Decentralization (Canada and Sweden)
In countries like Canada and Sweden, specialized nurses and teleconsultations play key roles in primary care. This reduces reliance on doctors for simple issues, freeing them to handle more complex cases. In Brazil, the pandemic accelerated telemedicine adoption, but regulatory and expansion efforts need to continue, especially in remote areas.
Prevention Incentives (Japan and Germany)
Instead of focusing solely on treating illnesses, countries like Japan and Germany invest in prevention programs, such as regular government-funded check-ups. This preventive healthcare focus not only reduces system costs but also improves citizens' quality of life. Expanding prevention campaigns and integrating these services into Brazil’s Basic Health Units (UBS) could be transformative.
Strengthening Local Networks (Chile and Portugal)
In Chile and Portugal, strengthening local healthcare networks by combining technology and human resources has shown promising results in expanding coverage. Brazil can learn from these models by investing in the training and retention of doctors and nurses in underserved regions.
The Role of Innovation
This is where innovation comes into play as a transformative force. A robust ecosystem of startups and health technologies can offer practical solutions for Brazil to overcome its challenges. Imagine a platform that integrates scheduling, teleconsultations, and patient follow-ups in one place. Or devices that remotely monitor chronic conditions, reducing the need for frequent visits.
National examples like InovaHC, at the Hospital das Clínicas of the University of São Paulo’s Medical School, and LAIS, at the Onofre Lopes Hospital in Rio Grande do Norte, are brilliant cases of how innovation can improve healthcare access. InovaHC promotes initiatives that integrate startups, artificial intelligence, and telemedicine to enhance patient care. Meanwhile, LAIS is a pioneer in assistive technology and information systems aimed at public health, with projects that improve SUS management and efficiency in various regions of the country.
Rethinking the Private Sector
Brazil’s private healthcare sector serves approximately 25% of the population, or around 53 million people, according to the National Agency for Supplementary Health (ANS). While it provides an important alternative for those seeking faster and more specialized care, the sector faces critical challenges that demand reevaluation.
A Sustainability Crisis
Rising supplementary health costs have been pressuring both providers and patients. From 2017 to 2022, the operational costs of health plans grew by an average of 13.7% annually, outpacing general inflation (IPCA), which was 4.6% during the same period, according to the ANS. These increases are reflected in annual plan adjustments, making access harder to maintain, particularly for the middle class.
The COVID-19 pandemic exacerbated this scenario. A surge in delayed exams and consultations during the pandemic’s peak led to spikes in healthcare costs. Moreover, the incorporation of new technologies and medications—often expensive—has directly impacted the financial balance of private providers.
Challenges in Access
Despite serving a significant portion of the population, private healthcare also reflects inequalities. Data shows that only 9% of the rural population has access to private plans, compared to 34% of the urban population. Additionally, the North and Northeast regions have the lowest coverage, highlighting the market's concentration in the South and Southeast.
Solutions for Transformation
To address these challenges, the private sector can explore several strategies:
Value-Based Models: Transitioning to a value-based care model, where payments are tied to health outcomes rather than service volume, can reduce waste and optimize resources. For instance, hospitals like Hospital Alemão Oswaldo Cruz have reported cost reductions and improved quality indicators using this model.
Prevention Investments: Programs for preventive care, such as remote monitoring of chronic conditions, can reduce avoidable hospitalization costs. A Deloitte study highlights that every dollar invested in prevention can save up to $3 in future healthcare expenses.
Technological Disruption: Adopting technologies like artificial intelligence and telemedicine can improve operational efficiency. According to the ANS, remote consultations have average costs 40% lower than in-person visits, without compromising care quality.
Flexible Plans and Microinsurance: Offering more accessible and flexible health plans, including microinsurance targeted at low-income populations, could expand the private sector’s reach. This approach has been successfully implemented in emerging markets like India and South Africa.
Moving Forward
Improving healthcare access in Brazil is a complex but achievable mission. Priority actions include:
Increasing SUS funding and ensuring equitable distribution of resources.
Encouraging technological innovation by fostering startups that develop tailored solutions for the healthcare sector.
Expanding prevention efforts by investing in education and community health programs.
Decentralizing care by empowering nurses and other professionals to lead primary healthcare efforts.
The Journey Continues: The Role of IBIS
João finally decides to visit the doctor. He arrives early at the public health clinic and, after hours of waiting, is seen by a caring but overburdened professional. Ji-hyun, on the other hand, completes another quick consultation and returns to work confident her health is in good hands.
João’s reality doesn’t have to stay this way. The Brazilian Health Innovation Institute - IBIS exists to add value to efforts aimed at transforming healthcare access in Brazil. Our role is to connect knowledge, unite talents, and support innovative solutions so stories like João’s can have a different ending.
IBIS believes change begins with collective action. With efforts to build public policies involving the entire health chain, João could have more options for care, leading to a more positive outcome in his healthcare journey.
Do you share similar or differing views on this article? We’d love to hear from you in the comments.
References
Voronoi Visual Capitalist. "Ranked: How Often People Go to the Doctor, by Country." Visual Capitalist. Disponível em: https://www.visualcapitalist.com.
OECD. "Consultations with Doctors." OECD Data. Disponível em: https://data.oecd.org/healthcare/consultations-with-doctors.htm.
OECD. "The COVID-19 Pandemic and the Future of Telemedicine." OECD Health Policy Studies. Paris: OECD Publishing, 2023. Disponível em: https://doi.org/10.1787/ac8b0a27-en.
OECD. "Health for Everyone? Social Inequalities in Health and Health Systems." OECD Health Policy Studies. Paris: OECD Publishing, 2019. Disponível em: https://doi.org/10.1787/3c8385d0-en.
InovaHC. "InovaHC – Transformação Digital em Saúde." Hospital das Clínicas, Faculdade de Medicina da USP. Disponível em: https://inovahc.hc.fm.usp.br/.
LAIS (Laboratório de Inovação Tecnológica em Saúde). "Inovação e Saúde no Brasil." Disponível em: https://lais.huol.ufrn.br/.
World Health Organization (WHO). "Global Health Expenditure Database." WHO. Disponível em: https://apps.who.int/nha/database.
Eretz.bio. "Eretz.bio – Startups de Saúde e Inovação." Hospital Israelita Albert Einstein. Disponível em: https://eretz.bio/.
by Marcio de Paula
Brazilian Health Innovation Institute - IBIS
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