SUS REFORMS AND COUNTER-REFORMS: PERSPECTIVES FOR PUBLIC HEALTH POLICY

Abstract

The analysis of the reforms and counter-reforms of the Unified Health System (SUS) highlights that public health policy in Brazil is developing in a context marked by institutional advances and setbacks imposed by fiscal and administrative constraints. A narrative review of the literature was conducted using databases such as the Scientific Electronic Library Online, Latin American and Caribbean Literature in Health Sciences, PubMed, the Virtual Health Library, the Journal Portal of the Coordination for the Improvement of Higher Education Personnel, the Institute of Applied Economic Research, the National Council of Health Secretaries, the National Council of Municipal Health Secretariats, and documents from the Ministry of Health, covering publications between 2023 and 2025. Descriptors such as "Unified Health System," "health financing," "fiscal framework," "primary health care," and "health regionalization" were used, intersected with Boolean operators AND and OR. The results demonstrate that recent initiatives, such as the introduction of the Primary Care Equity and Scaling Index and the incorporation of digital health, represent reform efforts that can strengthen the system, but still face obstacles related to insufficient resources and fragmented governance. The conclusion is that the future of the SUS will depend on its ability to consolidate reforms that ensure stable funding, inclusive technological innovation, and effective interfederative coordination, while resisting fiscal counter-reforms and policies that compromise universal and comprehensive health care as a constitutional right.