The political economy of health financing: Evidence from Brazil's Unified Health System

• Grant number: 25/03527-7
• Support Opportunities: Scholarships abroad - Research Internship - Doctorate (Direct)
• Start date: August 01, 2025
• End date: March 31, 2026
• Field of knowledge: Applied Social Sciences - Administration - Public Administration
• Principal Investigator: Elize Massard da Fonseca
• Grantee: Alexandre Handfas
• Supervisor: Joseph Harris
• Host Institution: Escola de Administração de Empresas de São Paulo (EAESP). Fundação Getúlio Vargas (FGV). São Paulo , SP, Brazil
• Institution abroad: Boston University (BU), United States
• Associated to the scholarship: 23/09432-2 - The politics of financing health in the context of universal healthcare, BP.DD

Abstract

Brazil's Unified Health System (SUS) is one of the largest public health systems in the world and an example of the expansion of universal health coverage. Since its establishment in 1988, the SUS has made substantial progress in improving access to healthcare and promoting equity. However, it continues to face persistent challenges related to financial sustainability. This study examines how its hybrid financing model-combining elements of social insurance, a national health service, and private sector participation-has shaped its trajectory and contributed to structural vulnerabilities. The research explores the political and institutional factors that have influenced this arrangement, including the role of political coalitions, bureaucratic dynamics, and private sector interests in shaping health financing debates, with particular attention to the crises of the 1990s and the impact of recent fiscal austerity measures.To deepen this investigation, the study will benefit from a research internship at Boston University under the supervision of Prof. Joseph Harris, a leading expert in the political sociology of health systems. The internship will provide access to specialized literature on health systems, participation in seminars and discussions with globally recognized scholars, and an academic environment focused on the political economy of health. This will enable theoretical and methodological refinement, as well as the development of a robust comparative framework. By positioning Brazil's experience within the broader global health policy debates, the research will enhance its academic relevance and impact, offering valuable insights for building resilient universal health coverage systems in politically and fiscally constrained settings.