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

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.
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