By Luã Santiago, Healthcare Systems Management Specialist
Orlando, Fla. l As health care debates continue to dominate public discourse in the United States, it is worth reflecting on lessons from international systems, even those facing severe challenges of their own. Having spent considerable time working with Brazil’s Sistema Único de Saúde (SUS), the country’s universal public health system, I see there are practical insights that could help strengthen U.S. health care delivery, especially around equity, coordination and data interoperability.
Brazil’s SUS is rooted in the principle of universal coverage: every citizen has guaranteed access to health care services without direct charges at the point of care, a concept that still eludes the U.S. national system. While the U.S. has expanded coverage through programs like Medicare and Medicaid and seen uninsured rates drop to roughly 9.9% among people under age 65, gaps remain, with millions still lacking adequate coverage or facing high out-of-pocket costs.
In contrast, SUS’s legal guarantee means that preventive care, chronic disease management and essential treatments are theoretically available to all Brazilians. This universality has enabled broad public health campaigns and contributed to significant improvements in key indicators, such as a dramatic reduction in infant mortality over past decades.
The U.S. spends more on health care than any other high-income nation, with national health expenditures reaching about $4.9 trillion in 2023, or approximately 17.6% of GDP, yet health outcomes often lag behind peer countries. Despite that high spending, Americans frequently give the system mediocre grades, especially on cost, with a majority reporting that health care expenses are a major concern, and nearly one-quarter describing the system as in crisis.
Moreover, many Americans struggle to afford care even when insured: nearly one in four report difficulty paying for prescription drugs, which total over $600 billion in annual spending, and millions delay or skip necessary care due to cost barriers.
What Brazil’s Experience Offers: Coordination and Public Health Orientation
One area where SUS’s experience is particularly relevant to the U.S. is coordination of care and integration of data systems. Brazil’s approach focuses on building networks of care that connect primary health teams with hospitals and specialty services, supported by national interoperability initiatives. This emphasis on continuity helps reduce fragmentation, a challenge that also plagues the U.S. system, where care often feels siloed between providers and payers.
Interoperability is not just a technical challenge but an organizational one. Brazil’s ongoing efforts to standardize data exchange across levels of care indicate how centralized platforms with strong governance can support seamless transitions between primary, specialty and hospital care, a lesson relevant for U.S. policy makers pushing toward data fluidity and value-based care models.
Brazil’s emphasis on family health teams and preventive care offers another lesson. By embedding multi-disciplinary teams into communities and prioritizing early intervention, SUS illustrates how investing upstream in primary care can reduce costly hospital admissions and improve population health. The U.S. has historically underinvested in primary care relative to specialty and hospital services, a factor cited by international analyses as contributing to poorer long-term outcomes despite high spending.
It is clear that Brazil and the United States differ greatly in economic resources, political frameworks and health system organization. No model is directly transferable, and SUS itself faces persistent challenges in quality variability, financing and regional inequities.
Yet focusing on equity, system integration and preventive care, principles at the core of SUS, could help U.S. leaders tackle persistent shortfalls in access, high costs and disjointed patient experiences. Achieving this will require sustained investment, meaningful data sharing, and a commitment to health care as a right rather than a commodity.
In an era where health system performance is under national scrutiny, drawing from diverse models can spark constructive debate and, ultimately, inform policy pathways that enhance care for all Americans.