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Can mothers rely on the Brazilian health system for their deliveries? An assessment of use of the public system and out-of-pocket expenditure in the 2004 Pelotas Birth Cohort Study, Brazil

DOI: 10.1186/1472-6963-8-57

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All deliveries occurring in the city of Pelotas, Brazil, during 2004, were recruited for a birth cohort study. All mothers were interviewed just after birth and three months later. Comprehensive data on the pregnancy, delivery, birth conditions and newborn health were collected, along with detailed information on expenses related to the delivery.The majority of the deliveries (81%) were financed by the public health system, a proportion that increased to more than 95% among the 40% poorest mothers. Less than 1% of these mothers reported some out-of-pocket expenditure. Even among those mothers covered by a private health plan, nearly 50% of births were financed by the SUS. Among the 20% richest, a third of the deliveries were paid by the SUS, 50% by private health plans and 17% by direct payment.The public health system offered services in quantity and quality enough to attract even beneficiaries of private health plans and spared mothers from the poorest strata of the population of practically any expense.Health costs in low and middle income countries can be an important source of expenditure and it has been shown that they can consume a high proportion of family income, up to catastrophic proportions. Brazil was identified as one of the countries with the highest proportion of households suffering from catastrophic health expenditure in a study comparing 59 countries[1]. This study showed that 10% of Brazilian households spent more than 40% of their capacity to pay (as catastrophic expenditure was defined), compared to 6% in Argentina and Colombia, 1.5% in Mexico, 0.5% in the US and practically zero in France and the UK. The only country with a similar result was Vietnam. Such a result is surprising given that Brazil offers comprehensive and free health services to all citizens through its national health system, the SUS (acronym for what could be translated into English as Unified Health System).The SUS was created in 1988, within the new Constitution, to offer f


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