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Ciência & Saúde Coletiva

On-line version ISSN 1678-4561Print version ISSN 1413-8123

Ciênc. saúde coletiva vol.12 n.4 Rio de Janeiro Jul./Aug. 2007 



Brazil's hospital system: status and challenges



The care provided by the hospital system is an important aspect of Brazil's National Health System (SUS) and its Supplementary Health System. Absorbing a large proportion of its financial, material and human resources, it responds to the healthcare needs of society, in parallel to more specific demands with high political and social visibility. Brazilian citizens perceive shortfalls in hospital care more clearly than the flaws of other types of social welfare, as they are the repositories of people's hopes and desires in times of trouble.

In parallel to the expansion of basic, medium and highly complex out-patient care, a steady stream of quantitative and qualitative alterations to diagnostic procedures and treatments, with shifts in the demographic, epidemiological, social, economic and cultural profiles of the population, are important aspects of the changes taking place in the financial and technical care models for hospitals. These changes have triggered crises and instability in hospital and non-hospital services, as well as healthcare systems in general and public opinion. It is becoming increasingly important and urgent to develop an in-depth understanding of the complex nature of these crises and the proposed alternatives for dealing with today's challenges.

The issue of hospital care is open to multiple approaches. The concept guiding this special edition is the presentation of papers written by practitioners, most of whom are (or have been) engaged in hospital management at differing levels and in various sectors. By presenting their views of the specific characteristics of public and private management, university services, public-private partnerships, government financing and the production of hospital information, this enterprise attempts to supplement the output on topics in the Collective Health field.

This is not a matter of claiming greater importance for hospital care, to the detriment of primary or out-patient facilities, but rather strives for closer integration / interaction among the many different layers and players of Brazil's healthcare systems. Fine-tuning their respective competencies, it attempts to build up a system that is steadily more able to respond effectively and accurately to the needs of the Brazilian people and society as a whole.

These discussion papers exhaustively chart the current (2007) issues affecting the hospital system in Brazil, supplemented by the discussants. Deliberate efforts have been made to include papers with widely differing approaches, views and topics, offering in-depth analyses of relevant, controversial or little-known aspects.

We thank the editors of Ciência & Saúde Coletiva for the opportunity to bring this enterprise to fruition, also expressing our gratitude to all the authors for their valuable contributions. We hope that this special issue will appeal to the widely varied universe of the readers of this journal, fostering the appearance of new prospects and innovative proposals for the hospital system in Brazil.


Ana Maria Malik, Hillegonda Maria Dutilh Novaes
Guest Editors