Metrics details. Health care is a complex economic and social system, which combines market elements and public and social interest. This combination in Brazil, like systems in China and United States of America, is operationalized through the public and private system. Therefore, this research describes and analyzes the complementarity of Private Health before the Brazilian Unified Health System, highlighting its main characteristics, scenarios, and trends in the face of the health system and the Brazilian market.
This descriptive and exploratory research uses secondary data from various sources, submitted to quantitative data analysis methods. The object of the research is the history of private health in Brazil and its main actors. The data are organized into three groups, each with its approach of collection and analysis. It is possible to perceive an intense trend of concentration of Brazilian private health in large institutions that have capitalized and have a great appetite for growth through mergers and acquisitions, whether from smaller operators or health institutions that integrate their health networks, following complementary health models already consolidated in countries such as China, and the United States of America, among others.
This concentration projects a market with fewer options and competitiveness, reduction in transaction costs and increase the operational effectiveness of health care.
Peer Review reports. Brazil is a country of continental dimensions, with a territory of 8. Since the s, many efforts have been devoted to health care in Brazil by public or private means. Although the efforts are commendable, the country presents many challenges around health [ 3 ] owing to the intense socioeconomic inequality present in the country [ 3 , 4 , 5 ]. This can be verified by the degree of income concentration, also known as a measure of inequality, the Gini index of Like the challenges of the Canadian [ 7 ] and United States of America systems [ 8 ], the Brazilian health system is formed by a complex and challenging network of health service providers and buyers [ 9 ], all with intense challenges of promoting an adequate cost-effectiveness ratio in health [ 10 , 11 ].
With the public and private actors, the Brazilian health system is divided into two sectors: public and private. The public sector comprises state funding; the private sector is financed by public and private resources, mostly for profit, and comprises different modalities of insurance and private health plans [ 12 ]. Table 1 describes the main characteristics of each of the members of the health sector in Brazil. Historically, private health systems have been stimulated by a series of government policies, either through the accreditation of services, and the remuneration and creation of hospital units among others [ 13 ].
