Dissertations, Theses and Capstone Projects

Date of Award

Spring 2013

Degree Type


Degree Name

Master of Public Administration (MPA)


Political Science

First Advisor

Dr. Andrew Ewoh


The proper building and administration of a strong healthcare system have been reasoned as a current challenge for professionals in charge of handling the variety of constraints existing worldwide. An array of issues related to ideology, cultural expectations, social values, and economic facets, to name a few, play a determinant role in the design and provision of healthcare services. Considering the current practices and obstacles for healthcare policy, this study delves into the characteristics of the healthcare systems in Brazil and the United States.

In Brazil, healthcare has been a constitutional right since 1988. As a result, financial barriers to access would not be a concern because citizens with limited income can be treated at no charge. However, the lack of proper investments may cast doubt on Brazil’s ability to carry out its legislative intent of making healthcare a universal right. Conversely, in the United States, healthcare is a market-driven venture with some aspects of a unified healthcare structure similar to what is accessible in Brazil.

This study is a qualitative research that uses an exploratory case study to compare the healthcare systems in Brazil and the United States. This comparison focuses on the organization and financing of the healthcare settings in both countries, with more emphasis given to the differences through which each system is performing on the basis of costs and accessibility.

The research aims to answer two major questions: (1) How are the healthcare systems of Brazil and the United States of America organized? (2) In what ways do the costs and investments in both systems help to shape the provision of healthcare services? This case study evaluates a collection of available documents, legislation, and pertinent literature on the subject to provide a descriptive comparative analysis.

In assessing the overall aspects of healthcare provision, this study concludes that both Brazil and the United States rely on private and governmental institutions. The provision on the Brazilian side is focused on primary care, holding a system highly dependent on private resources for secondary and tertiary care. While primary care initiatives are considered to be an important step towards the consolidation of a healthy population, the lack of supply for specialized care may be deemed as a limitation of the system. In the United States, unlike in Brazil, there is high availability of resources for specialized care and a shortage of general physicians to provide prevention and primary care at desired levels. This might be considered to be a drawback because while the country holds a refined healthcare system, the benefits of preventive measures are missed.

In evaluating how the costs and expenditures of healthcare services influence the level of healthcare provision, this study concluded that both systems currently face problems. The economic aspect of healthcare provision in Brazil demonstrates that the country clearly lacks the proper resources to provide equitable and effective healthcare to its population. In spite of major initiatives on primary care and prevention through the Unified Health System, the coordination of healthcare provision is impaired due to lack of proper resources. In the United States, the costs for healthcare services reached the highest level as compared with any other country in the world. Nonetheless, the uninsured rates have been steadily increasing in the last few years, leading the country to a situation in which the citizens get insufficient access even when paying more for it.

One major recommendation from this study is that a wider investment for primary care in the United States would provide for a balance between the three tiers of care, as well as to

guarantee widespread measures for cost control through the practice of preventive care. In regards to the overall organization in Brazil, a major initiative towards proper governmental investment could reduce the dependency relation with privately owned medical resources. This study also recommends that public administrators in Brazil should closely evaluate the likely drawbacks of a trend that has been materialized in Brazil through the opening of healthcare markets to foreign capital.

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