The topic of health care has become the most pressing and ongoing debates for not only the United States but also many other nations around the world. Many countries have implemented a universal health coverage for years with effective results. While the United States steps into a immature national health care program, the government can observe Brazil’s health care system to learn valuable lessons. The type of health care system a country chooses has a major effect on the country’s health care professionals. While comparing the health care professionals of the United States and Brazil, many similarities can be seen; however, the United States can learn many lessons from Brazil.
A Comparative Analysis of Health Care Professionals in Brazil to Those in the United States
The latest topic in the United States today, is the subject of healthcare reform in the United States. With the Patient Protection and Affordable Care Act (ACA) upheld by the Supreme Court in 2012, Americans everywhere have formed an opinion about the new national health care system—most opinions viewing the national system as negative. However, several developed nations similar to the United States have partaken in a national health care system for years. The large nation of Brazil has utilized a national health system since 1923, and has seen both positives and negatives. Many Americans see the supply and demand of health care professionals as a potential threat to the future of the ACA and the United States as a whole—a definite issue that has affected Brazil.
In Brazil, health care is viewed as a constitutional right being offered by private and government organizations and is an obligation of the state. Through the Unified Health System (SUS), public health care is universal and provided free of charge to all Brazilian permanent residents. In addition to the United Health System, Brazilians also have private based health insurance coverage which the wealthier population can usually purchase, and Brazilians can be offered health coverage by their respective employers if available. As of 2003, 174.6 million Brazilian residents receiving benefits from the SUS were documented. Of the 174.6 million, 475,699 healthcare professionals existed within Brazilian health care. In 2012, the total percentage of GDP spent on health expenditure in Brazil was at a four-year high of 9.3%.
However, Brazil’s health expenditure is far lower than the United States health expenditure that spent a total of 17.9% in 2012. In Brazil the average life expectancy has been on the rise since 2000. In 2010, average Brazilian life expectancy was reported at 73.5 years with a life expectancy for men at 69.7 and for women at 77.3. The infant mortality rate in Brazil has been decreasing over the years, but is still considered high for a developed nation. Maternal mortality rate in Brazil is also decreasing in years and would be considered average compared to other countries. In an attempt to improve the national health care system in Brazil, the Brazilian government established the “Mais Medicos” program, or more doctors program, in 2013. The project was aimed to create close to 1,000 jobs for physicians to tend to patients in the 22 states that have fewer doctors than the national average—most of the states lying in the Northern region of the nation.
In addition to their salaries, doctors are provided financial aid to cover housing and sustenance per municipalities of the government. The program will employ physicians temporarily while the Brazilian government looks to increase attendance to Brazilian medical schools over a short amount of time by offering substantial amounts of financial aid and increasing expenditures on medical school scholarships. Originally, the program was offered to Brazilian resident doctors only in an attempt to bring doctors from the more populated and urban areas to the rural and less populated areas. When few residential doctors applied, the Brazilian government extended Mais Medicos to Brazilian doctors who received their education overseas and foreign doctors. Prior to applying, it was suggested that applicants should have a general understanding of the Portuguese language in order to be accepted into the program.
At the end of the application process, nearly 20,000 doctors had submitted applications with listed preferences of the cities that they wish to work in. Doctors involved in the program are required to work 40 hours a week for three years and may work no longer than 6 years in the program. The physicians accepted into the Mais Medicos program receive 10,000 Brazilian Reals (an equivalent to $4,501 US dollars) per month to spend on housing and necessities. During 2013, Brazilian President Dilma Rousseff imported nearly 11,000 Cuban physicians to serve in the program. Cuban physicians were to serve similar hours, but their salaries would be sent to the Cuban government who would distribute 40%-50% of the earnings to the physicians working in Brazil. This exchange has been an ongoing debate between the medical community of Brazil and its government. The benefits listed above are considered to be beneficial to physicians.
The life expectancy, infant mortality rate, and maternal mortality rate are all at a good standing compared to recent generations in Brazil; therefore, the physicians having these characteristics as a resume topic shows that they were a part of a “change” in Brazil. Although the Mais Medicos program seems to have some flaws and a definite group that disapproves of it, it also is seen by many to do well for the health care system in Brazil and has many supporters. The common problem in Brazil for health care professionals seems to be a lack of distribution of doctors into the more rural areas of the country. On average in Brazil, there are only 2 hospital beds per 1,000 people. In the northern regions of Brazil, where more rural areas are found, the amount of hospitals per resident is lower than the average. Much like in the United States, doctors are very reluctant to the thought of beginning a practice in a small rural town. Reasons being that small rural towns are usually less populated and on average bring in less household income.
In Brazil, the idea of practicing medicine in these depressed areas is even less glamorous because of the government involvement in health care. In these areas, practices receive less attention including lack of supplies and infrastructure. Physicians located within wealthier and more populous areas have slightly better access to equipment and infrastructure, but the conditions differ only slightly. Doctors are extremely rushed with a constant overflow of patients and consistently working in hot rooms with little air circulation. This is problem does not only exist in the public clinics of general physicians. Specialist physicians have a persistent flood of patients who do not need a specialist’s care, but seek the specialist because there is no general physician available. Another challenge that Brazil’s physicians face is the complete absence of electronic health records (EHRs).
Although electronic health records can be difficult and costly to implement, the benefits of them to a health system that lacks infrastructure can be monumental. EHRs improve quality, convenience, care coordination, practice efficiencies, and cost efficiencies. Implementing electronic health records would improve the quality of Brazil’s physicians work environment. The last challenge Brazil physicians face is the existence of corruption within the system. One example includes Brazil’s wealthier population paying physicians under the table to treat them before others. While some patients are in dire need of an operation or treatment, a wealthier patient has the opportunity to offer the physician an amount of money that will sway the physician to treat their situation before others—even though the others have been waiting an extended amount of time.
Unfortunately, these types of situations are not illegal in Brazil; therefore, it happens frequently. In the United States, health care has only recently been provided as “universal coverage”. It is an ongoing debate to whether health care in America is a right or a privilege. The United States has always offered free health coverage to the elderly and the poor—paid for by taxpayers. In 2010, Medicare and Medicaid covered at least 112,979,783. In addition to Medicare and Medicaid, most of the American population has chosen to receive employer-based health coverage. The number of Americans with employer-based health coverage, however, has been declining since the discussion of the Affordable Care Act. Since the Affordable Care Act has come about, over 8 million people have signed up for coverage with 87% of the newly insured being previously uninsured. In 2012, the World Bank reported that there were 2.5 physicians per 1,000 people.
In 2012, the total percentage of GDP spent on health expenditure in the United States was at a 17.9%. This total is far greater than the amount of GDP spent on health expenditure in Brazil. In the United States the average life expectancy has steadily increased over generations. The life expectancy reported in 2012 was 78.7 years. Although it would normally be a slight age difference, it is an incredible gap for life expectancy with Brazil at 73.5. The infant mortality rate in the United States has been steady over recent years at 6 deaths per 1,000 births. Maternal mortality rate is significantly lower in the U.S. than Brazil with Brazil at 69 deaths per 100,000 births and the United States at 28 deaths per 100,000 births. Overall, physicians working in the United States would have a greater professional advantage over those who practice in Brazil.
Not only does the United States report superior statistics for life expectancy, infant mortality rate, and maternal mortality rate, but the United States is generally a wealthier nation than Brazil. Because the United States has been a democracy for over 200 years and because of their general wealth, it is likely that the United States is in a better position to take over a health care system plan like Brazil’s. Much like Brazil, the United States new ACA health care plan has cut the uninsured rate in half and will continue decreasing the number of uninsured over the next several years. In regards to the corruption that Brazil faces on a daily basis with the wealthy paying physicians under the table, the United States cannot completely rule out the possibilities of that happening within the new health care system. However, regulations and laws have been established to prevent such situations.
While there are many benefits to becoming a healthcare professional in the United States, there are also some challenges. One of the greatest challenges that physicians in the United States will face under the ACA is the growing number of patients who need to be seen by a doctor. New patients will flood waiting rooms with problems that may be preexisting with no prior treatment. However, doctors may not mind seeing more patients per day, because the amount of insurance reimbursement doctors receive will continue to decline. This is because the Affordable Care Act not only set out to achieve health care for more Americans, but it also set out to decrease overall health care costs.
With the discussion of the ACA causing insurance reimbursement shrinkage and higher insurance premiums, it will become more costly to run a private practice. Overall, both the United States and Brazil’s health care system have their advantages and disadvantages. While American physicians are struggling with shrinking reimbursements and a surplus of patients, Brazilian physicians are struggling with a lack of equipment and supplies and are challenged by corruption regularly. While it seems that the United States is leaning towards a similar health care system to Brazil’s United Health System, Americans can correct the mistakes made by Brazil in regards to the treatment and use of its health care professionals.
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