Plausible Outcomes for Healthcare in the Wake of Brazil’s Presidential Runoff


Although Brazil is one of the world’s top pharma markets, with the highest market value in Latin America, and has made major strides towards universal healthcare, the country continues to recover from its worst recession ever and the fallout from its disastrous COVID-19 response. Brazilian voters are preparing for a presidential runoff that pits two highly polarized candidates against each other once again, with public health pinpointed as a key concern for both, but the impact the winning candidate will have on healthcare remains to be seen.


Brazil with its population of 214.00 million is on the list of the world’s leading pharma markets and is the Latin American country with the highest pharmaceutical market value, amounting to nearly USD 21 billion in 2021. The country has also made huge progress in providing universal healthcare with the adoption of the Sistema Único da Saúde (SUS) in 1988, which has brought primary healthcare to millions of people and increased the country’s life expectancy.


In spite of these encouraging facts, Brazil has also faced a major recession and continues to grapple with the long-term effects of the COVID-19 pandemic that caused some 700,00 deaths. The SUS system also suffers from underfunding and a lack of doctors while nearly 70 percent of the country’s hospitals remain in the private sector, according to Global Health Intelligence.


While SUS has improved access to medicine for many Brazilians, those who can afford it often turn to the private sector to avoid the waiting lists associated with the public system. According to the World Health Organization, the proportion of health spending from private healthcare is around 57 percent, with over half of that spending coming from out-of-pocket payments, mainly for medicines.


In a recent national survey carried out by private polling firm Quaest Consultoria, Brazilians’ top concerns, apart from the economy and corruption, were social issues including public health. How these sentiments will affect the upcoming presidential runoff that will again confront former President Luiz Inácio Lula da Silva (Lula) of the left-wing Workers’ Party (PT) and Jair Bolsonaro of the conservative Liberal Party (PL) is still open to speculation, but with inflation already at 9 percent and the country’s gross debt-to-GDP ratio at 90 percent, the winning candidate will have to face considerable economic headwinds.


Should incumbent Bolsonaro, who positions himself as the business-friendly candidate and who backs an open-market economy, win, some predict economic growth with factors such as the privatization of public companies. Many of Bolsonaro’s previous decisions, however, have come under heavy scrutiny, including his handling of the COVID-19 pandemic. If his previous funding cuts for federal education are any indication of future policy, he may decide to slash spending on SUS and other public programmes.


If Lula, who claims to champion economic and social justice, comes out a winner, some predict the return of large-scale public investment projects and social assistance programs, that characterized his former terms as president and saw total health expenditure rise from 7.0 percent to 8.3 percent of GDP. However, these policies coincided with a long rally in global commodity markets from 2003 to 2010, during which led Brazil’s resource-based economy soared, an altogether different economic climate from today.

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