Skip to Main Navigation

The political economy of health services provision and access in Brazil (English)

The authors examine the impact of local politics and government structure on the allocation of publicly subsidized (SUS) health services across municipios (counties) in Brazil, and on the probability that uninsured individuals who require medical attention actually receive access to those health services. Using data from the 1998 PNAD survey they demonstrate that higher per capita levels of SUS doctors, nurses, and clinic rooms increase the probability that an uninsured individual gains access to health services when he, or she seeks it. The authors find that an increase in income inequality, an increase in the percentage of the population that votes, and an increase in the percentage of votes going to left-leaning candidates are each associated with higher levels of public health services. The per capita provision of doctors, nurses, and clinics is also greater in counties with a popular local leader, and in counties where the county mayor and state governor are politically aligned. Administrative decentralization of health services to the county decreases provision levels, and reduces access to services by the uninsured, unless it is accompanied by good local governance.


  • Author

    Mushfiq Mobarak, Ahmed Rajkumar, Andrew Sunil Cropper, Maureen

  • Document Date


  • Document Type

    Policy Research Working Paper

  • Report Number


  • Volume No


  • Total Volume(s)


  • Country


  • Region

    Latin America & Caribbean,

  • Disclosure Date


  • Doc Name

    The political economy of health services provision and access in Brazil

  • Keywords

    public provision of health care;political economy of health;access to health-care;access to health care;public health care provision;decentralization of health care;level of health care;provision of health service;decentralization of service delivery;public health care services;health care per capita;demand for health services;local public service provision;access to health service;household per capita income;quality of health services;spatial distribution of population;public health service;private health insurance;local public good;health care access;adequate health care;public service delivery;measure of governance;local tax revenue;basic health care;types of service;public goods provision;health care facility;decentralization in health;health care facilities;Politics and Government;quality of governance;health care system;local government budget;indicators of governance;brazilian case;agriculture and service;payment for service;sustainable socioeconomic development;large urban areas;household and individual;private health care;Health Service Delivery;primary school education;class of people;health care establishments;allocation of resource;health care resources;primary health care;decentralization of authority;Political Economy Analysis;per capita health;health inputs;federal government;medical attention;political participation;standard deviation;public budget;health budget;uninsured person;health facility;good governance;survey questions;marginal benefit;political variable;rural area;spatial autocorrelation;summary statistic;voter preference;state capital;political alliance;political negotiation;county health;political parties;income inequality;federal transfer;blood pressure;vote population;tax rate;geographic distribution;political party;positive impact;formal sector;political connections;Population Density;sample mean;moment estimator;household income;illiteracy rate;respiratory disease;administrative decentralization;health council;preferential access;metropolitan area;spatial correlation;elected officials;survey respondent;empirical model;local development;government structure;private doctors;health module;local election;public clinic;uninsured individuals;local politician;political factor;marginal utility;social exclusion;Public Services;provision level;voter turnout;political patronage;ceteris paribus;informal sector;theoretical model;comparative analysis;rural economy;nash equilibrium;optimization problem;decentralization increase;party platform;household size;special interest;spatial model;equal distribution;Tax Cost;planning capacity;budget constraint;Fiscal Federalism;measure of use;Fiscal Sustainability;potential users;prescription drug;waiting time;adequate information;household fall;independent variable;multiple choice;economic stability;diagnostic services;spatial patterns;inpatient facility;inpatient facilities;temporary housing;nursing auxiliary;slum area;geographical location;national statistical;education level;participation rate;geographic neighbors;statistical significance;interaction effect;urbanized area;geographical area;academic publishers;government investment;hospital bed;healthcare system;geographic boundaries;population data;stratified sample;fund allocations;health status;regression sample;participatory politics;sample survey;local politics;community health;governance measure;budget following;smaller households;governance quality;positive externality;positive correlation;living condition;organizational structure;household level;political outcome;private provider;healthcare worker;political condition;Health policies;administrative structure;federal officials;relative weight;political power;governance capacity;decentralization variable;household survey;public official;education category;educated people;individual characteristic;geographic variable;household characteristic;military regime;health provision;local preference;civil society;health problem;equal access;constitutional requirement



Official version of document (may contain signatures, etc)

  • TXT*
  • Total Downloads** :
  • Download Stats
  • *The text version is uncorrected OCR text and is included solely to benefit users with slow connectivity.


Mushfiq Mobarak, Ahmed Rajkumar, Andrew Sunil Cropper, Maureen

The political economy of health services provision and access in Brazil (English). Policy, Research working paper ; no. WPS 3508 Washington, D.C. : World Bank Group.