Based on a revision of literature and on data from official databases (DATASUS and IBGE), and international agencies, we discuss segmentations and specializations of health service supply in Brazil. The institutionalist framework employed in this analysis takes into account relationships between public and private subsystems and the various actors interacting to shape the health system in accordance to their specific interests and convictions. Constraints to the development and implementation of social policies generated by macroeconomic adjustments and agreements between major actors contribute to the Unified Health System's (SUS) present tendency of specializing in low-cost and simplified health-delivery technologies, contrasting with the more dynamic private sector's tendency of specializing in segments dependent on high and intermediate levels of technological incorporation. This pattern tends to attract private-insurance buyers and to include procedures which are better-paid in contracts with the public sector. A stronger presence of health councils and of other still under-represented actors in the political arena could favour deeper reflection on the potential impacts of this specialization pattern.
Brazilian Unified Health System; Supplementary health; Public policies; Health financing