The Evolution of HTA in Emerging Markets Health-Care ... - TREE

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OHE Consulting Report for PhRMA 5 January 2011 Annex 1: From Elias (2009) Annex 2: Pre-‐SUS History Timeline Before 1900 Until the end of the 18th century the government acted only in cases of epidemic 1923 Creation of the National Department of Public Health, responsible for initiations in collective health (urban and rural sanitation, infant, industrial and professional hygiene, supervision, health in the harbours and combating rural endemics). For medical and dental assistance, treatment was paid out of pocket. 1923 Eloy Chaves Law creates the Cash of Retirement and Pension (CAPs), organized by companies considered strategic for the national economy at the time (rail, port). Financing came from employers and employees contributions. Only workers who contributed to the CAPs were entitled to receive medical assistance. What was offered in terms of medical assistance was defined by each CAP depending on the needs of each specific company and the financial resources available. The presidents of the CAPs were named by the Brazilian president, despite the government not contributing to the finance of the system. 1931 Creation of the Ministry of Education and Health 80
OHE Consulting Report for PhRMA 5 January 2011 1932 CAPs were growing and 140 COPs covered almost 40.000 associates 1933 Creation of the first Institutes of Retirement and Pension (IAPs), which was organized by work category. In these Institutes, the government also contributed with the financing of the system, maintaining also the contribution from employers and employees. With the creation of IAPs, the government centralized health initiatives, having as primary interest the creation of a social insurance system that guaranteed the health of workers. 1949 Creation of the Service of Domiciliary Urgent Medical Assistance (SAMDU), which defined the right to medical assistance in case of urgencies for all citizens and was financed by all IAPs together. Until 1960 Predominance of IAPs, which privileged social security instead of health care 1960 All IAPs were centralized in a unique State institution, creating the National Institute of Social Security (INPS), which centralized health care provision for workers that contributed to the system. With this, there was the creation of the health care provision system, composed by three systems: proprietary (hospital network and health units property of Social Welfare, as well as professionals receiving wages from the State), accredited contractor (system of payment by service units), and “conveniated” contractor (pre-payment system). 1977 Creation of the National System for Pension and Social Assistance (SINPAS), which segmented actions related to pensions and to medical assistance. It was composed by the Institute of Financial Administration of Social Security (IAPAS) and by the National Institute of Medical Assistance (INAMPS). INAMPS continued to privilege “conveniated” private providers to increase the number of providers for the State. The system started to grow with private capital instead of investing in improving public providers. 1980 The system provides poor health care, with long waiting lists, low wages, bad work conditions, generating growing dissatisfaction of the population with the quality of medical assistance. Financial resources were mismanaged and cases of corruption started to be frequent. Besides that, the population was aging and the first contributors to the pension system were starting to retire and receive their pensions, for which there was not enough money. 1980’s Sanitary Movement: With political opening, movements in defence of a broader and democratic health policy are formed. In 1979 they proposed a structure for a new Unified Health System, incorporating successful initiatives from other countries, such as the universal right to health, integrity of actions, and democratization of the system. The prioritization of the government in previous years for the private capital in health care, however, created strong interests against changes in the system that bought profits to private hospitals. 81
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The Evolution of HTA in Emerging Markets Health-Care ... - TREE

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