Healing People, Part II: Brazil on $300 a Year

RIO de JANEIRO—My wife and I got used to Lourdes' annual departures. Our maid's happy chatter would transform into vague grumblings and complaints about dores nos ossos—the pain in her bones. She'd start in on her cachaça-drinking husband, the alcoholic, and her many humiliations at the hands of the mouthy, pregnant teenage girls who roam Caju, the drug gang-dominated Rio de Janeiro slum, or favela, where she lives. Lourdes would say she missed her elderly mother in Paraiba, a poor state in Brazil's northeast. She'd say it was time to retire. Then we'd pay her and chip in a few extra hundred reais for the four-day bus ride to Paraiba and she'd leave.

A few months would pass before Lourdes returned and, after a year, the cycle would repeat itself—the pain in her bones, the humiliation of Caju, the visit to her mother. Then, six years ago, Lourdes didn't come back. We had all but given up hope of ever hearing from her again when her husband Francisco called. "Please, can you help? Lourdes tried to burn down the house and then ran away."

Deep in rural Brazil, Lourdes had been put in a mental hospital. Conditions were appalling, and Francisco helped her escape. But back in Rio, she had another episode. Francisco took her to another mental hospital for observation, and she was committed and diagnosed with bipolar disorder. Since then, all of her treatment—including drugs and once-a-month counseling—have been free. Today, she is living at home and working for us a few days a week. We give Francisco odd jobs, too. On her meds, Lourdes is her charming old self.

All in all, Lourdes's story wound up a happy one, but her diagnosis might apply to the system that tried to help her: it's bipolar. While new hospitals open throughout the country, the failure to provide the staff or the budget to maintain them has facilities falling into neglect just weeks after ribbons are cut. Thousands of Brazilians who have government—but not private—health coverage wait years for surgery. Doctors ditch their low-paying government jobs to see private patients, and don't show up for work at public clinics or hospitals. First-class emergency rooms and trauma centers are attached to underfunded, under-staffed, dirty and disorganized hospitals. Universal drug programs for AIDS, hepatitis and tuberculosis exist alongside wasteful and destructive pharmacy subsidies. Through corruption and bad management, hundreds of millions of dollars in antibiotics and other important drugs are lost every year.

Hey Big Spenders

In 2009, Brazil's government spent $367 per person on health care, according to the United Nations Development Program. That's one-fourteenth as much as Luxembourg's government, the world's biggest per-capita spender. It's less than one-eighth the $3,074 spent by the U.S. government. Brazil's federal government spends 3.6 percent of the nation's gross domestic product on health care, according to Sérgio Piola, a researcher at Ipea, Brazil's Applied Economics Research Institute. That represents some $56 billion out of the $2.03 trillion GDP that Brazil, the world's eighth-largest economy, generated last year. According to Piola, Brazil must spend at least 6.5 percent of its GDP, or $132 billion a year, if it wants to fulfill its goal of a functioning universal health care system.

Even compared to the rest of Latin America, Brazil's government is well down the list of health spenders. Neighboring Argentina allocates more than twice as much —some $758 per capita annually—while Cuba spends $329 and Mexico $327. All three countries have better health care ratings and higher UN social-development rankings than Brazil. In the private sector, when private health care outlays are added, Brazil's spending leaps to 8.4 percent of gross domestic product—about $855 per person. In other words, this developing economy spends almost the same percentage of its national income on health care as the developed countries that...