Health clinic · Health and the SUS
Where the SUS came from and why it matters
Before Brazil's public health system existed, getting care depended on having a formal job. This is the story of how that changed, what exists today and what is still missing.
Before 1988
Health care depended on your work card.
People with a signed work card (the carteira assinada, proof of a formal job) were treated by INAMPS, the Social Security medical care institute. A few paid for a private doctor.
The rest of the country had no guaranteed right to anything. Farm workers, day cleaners and the unemployed knocked on the doors of the Santas Casas, Brazil's charity hospitals, and were treated, when they were treated at all, as indigents.
1986 to 1990
Brazil wrote a new sentence.
Health is the right of all and the duty of the State.1988 Constitution, Article 196
The idea came out of the 8th National Health Conference, in 1986, and went into the Constitution two years later. The law that created the SUS (Sistema Único de Saúde, the Unified Health System) dates from September 19, 1990.
From then on, no one had to prove they had a job to get care.
Today
What is inside the SUS
- Neighborhood clinic
- Vaccines
- SAMU 192 ambulance
- Free medicine
- HIV treatment
- Transplants
- CAPS mental health centers
- Health inspection
Almost nine in ten Brazilians use the SUS (89.3%). In 2025 there were more than 31,000 transplants, and the SUS paid for about 86% of them. HIV treatment has been free since 1996 and reached about 770,000 people in 2024.
Another path
Where there is no SUS, illness can turn into debt.
In the United States, health care almost always depends on insurance. In 2024, 8% of the population had none: about 27 million people.
Even with insurance, the bill comes. About 41% of American adults owe money to a doctor or a dentist.
The United States also has public programs, for older people and for the poorest. And those who defend the American model point out how quickly people with good insurance get care.
What the SUS still owes
The waiting line is real.
More than 80,000 people are waiting for a transplant. And 45.4% of Brazilians say they do not trust the quality of care.
Part of the problem is money: Brazil spends about 3.8% of its GDP (the value of everything the country produces) on public health, and the Pan American Health Organization (Opas) recommends 6% for a system open to everyone. Another part is organization: many people wait for a specialist over a case the neighborhood clinic could have solved.
The two sides
Both want a shorter line. They disagree on how to get there.
People who vote left
“Health care is a right. The SUS does a lot with little.”
Why they think so
People who think this way remember the time when only those with a work card got care. And they see that the market does not open hospitals where there is no profit.
What they propose
More public money, more Family Health teams, careers for health workers and national production of vaccines and medicines.
People who vote right
“More money without good management turns into a line all the same.”
Why they think so
People who think this way see the line, the hospital without doctors and the news about money being diverted. And they place more trust in those who have to compete for customers to survive.
What they propose
Partnerships with private hospitals and nonprofit social organizations, targets with accountability for results, and cheaper health plans, to take people out of the SUS line.
And corruption?
Embezzlement is fought with oversight.
Money does get diverted in health care, and those who divert it must be investigated and punished. On this, both sides agree.
The disagreement comes next. Critics say a system this large needs much more control, and they are right to demand it. Defenders of the SUS reply that shutting the service down punishes the patient, not the thief: when someone steals the school lunches, the answer is to punish the thief and keep the school open.
To take with you
If the SUS ended tomorrow, what would change for your family?
Think of the last vaccine, the last test, the relative who takes medicine every month. You don't have to answer to anyone.