Health Care Reform in Latin America and Implications for the Hospital Sector World Hospitals and Health Services – Health Care Reform in Latin America and Implications for the Hospital Sector Vol. 51 No. 2 22 Brazil’s Mixed Public and Private Hospital System ABSTRACT: Brazi l ’s hospi t al sector is vibrant and growing. Under the 1988 Brazi l i an const i tut ion all ci t i zens have the right to heal th care, ant icipat ing the global commi tment to Universal Heal th Care. Brazi l ’s publ ic sector prides i tsel f on having one of the worl d’s largest single payer heal th care syst ems, but complement ing that is a signi ficant and larger privat e sector that is seeing big increases in investment, ut i l i zat ion and prices. This art icle out l ines the structure of the hospi t al syst em and analyzes the nature and direct ion of privat e heal th sector expansion. T wenty-six percent of Brazi l i ans have privat e heal th insurance and al though coverage is concentrat ed in the urban areas of the Southeast ern part of the country , i t is growing across the nat ion. The disease burden shi f t to chronic diseases aff ects the nature of demand and direct ly aff ects overall heal th care costs, which are rising rapidly outstripping nat ional inf lat ion by a f actor of 3. Increasingly costs wi ll have to be brought under control to maint ain the vi abi l i ty of the privat e sector . Adapt at ion of int egrat ed care networks and strengthening of the publ ic reimbursement syst em represent import ant areas for improvement. P rovi d ers a nd Pa yers i n t h e Heal t hcare Sys t em. The hospital sector has approximately 6300 general and specialized hospitals, ranging from small, low quality public and private hospitals to world class private and public research hospitals. A large segment of the private market is made up of small, inefficient facilities that are costly to operate (La Forgia and Couttolenc 2008). Most private hospitals provide services to public and private patients, as it is shown in Figure 1. FIGURE 1: SUMMARY OF PUBLIC AND PRIVATE HEALTH CARE FACILITIES IN BRAZIL, 2014 Source: IESS 2015; SIA/SUS 1 Thanks to Alex Spevak for expert research assistance for this paper and the associ- ated PowerPoint. MAUREEN LEWIS CO-FOUNDER AND CEO OF ACESO GLOBAL; VISITING PROFESSOR AT GEORGETOWN UNIVERSITY’S SCHOOL OF FOREIGN SERVICE, USA EVANDRO PENTEADO PLANNING AND QUALITY MANAGER AT THE PRIVATE HCOR HOSPITAL, SÃO PAULO, BRAZIL ANA MARIA MALIK FULL PROFESSOR, ESCOLA DE ADMINISTRAÇÃO DE EMPRESAS, FUNDAÇÃO GETULIO VARGAS, SÃO PAULO, BRAZIL