Universal Hearing Health Care: Brazil The public health system in Brazil, called Sistema Único de Saúde (SUS or Unique Health System), guarantees all Brazilians, regardless of social status, race, or ethnicity, free and equal access to health care in all areas of specialty. Nearly 6 million Brazilians—or 4% of the population—have hearing loss, according to ... World Beat
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World Beat  |   December 01, 2008
Universal Hearing Health Care: Brazil
Author Notes
  • Maria Cecília Martinelli Iorio, PhD, is a professor of audiology in the Department of Phonoaudiology at Federal University of São Paulo in Brazil.
    Maria Cecília Martinelli Iorio, PhD, is a professor of audiology in the Department of Phonoaudiology at Federal University of São Paulo in Brazil.×
  • Leticia Pimenta Costa, MS, is an audiologist at the Clinical Hospital of the Federal University of Minas Gerais in Belo Horizonte, Brazil.
    Leticia Pimenta Costa, MS, is an audiologist at the Clinical Hospital of the Federal University of Minas Gerais in Belo Horizonte, Brazil.×
Article Information
Hearing & Speech Perception / Hearing Disorders / International & Global / World Beat
World Beat   |   December 01, 2008
Universal Hearing Health Care: Brazil
The ASHA Leader, December 2008, Vol. 13, 15. doi:10.1044/leader.WB3.13172008.15
The ASHA Leader, December 2008, Vol. 13, 15. doi:10.1044/leader.WB3.13172008.15
The public health system in Brazil, called Sistema Único de Saúde (SUS or Unique Health System), guarantees all Brazilians, regardless of social status, race, or ethnicity, free and equal access to health care in all areas of specialty.
Nearly 6 million Brazilians—or 4% of the population—have hearing loss, according to the 2000 census. The government began the National Policy of Hearing Health Care program in 2004 to provide assistance for people with hearing loss. The program provides free access to all hearing health care services, including identification, diagnosis, treatment, and hearing aid fitting and rehabilitation. One important distinction in this program is the post-fitting monitoring, with a minimum of semi-annual follow-up visits for children and annual visits for adults.
Services are divided into three levels of care: basic care and medium- and high-complexity services. Basic care includes health promotion and the prevention and identification of hearing problems through public education programs as well as guidance for pregnant women, educators, and health professionals about the identification of the risks for hearing loss.
Medium- and high-complexity services are available to regions with a population of at least 1.5 million through 113 accredited mobile units that provide specialized services for the diagnosis of hearing loss, selection and fitting of hearing aids, and speech treatment. Regional services are delivered by a professional team that consists of an otorhinolaryngologist, four phonoaudiologists, a social worker, and a psychologist. The otorhinolaryngologist is responsible for the medical diagnosis and, if needed, medical treatment. Phonoaudiologists, who have an advanced degree (master’s or doctorate) that combines training in both audiology and speech-language pathology, provide audiological evaluation, hearing aid selection and fitting, and nonmedical treatment. The social worker assists the patient with social adjustment and any funding issues; the psychologist provides patient and family counseling.
High-complexity services, delivered by a specialized team, are for unique populations, including children under age 3, patients with additional visual or neurological disorders, and those with specific auditory impairments such as central auditory disorders, auditory neuropathy, and unilateral hearing loss. This team consists of two otorhinolaryngologists, one neurologist, one pediatrician, six phonoaudiologists, one social worker, and one psychologist. Cochlear implants and training for specialists to program them are available, but Brazil has few specialized cochlear implant centers. As a result, many who would benefit from cochlear implants do not receive them.
Statistics from the National Policy of Hearing Health Care provide an overview of service utilization. In 2006, 65% of the population who received diagnostic services for hearing loss was 15–65 years old; 44% of those who received hearing aids were 15–65 years old and 44% were older than age 65. About 62% of the speech services were provided to children and teenagers from birth to age 15.
The public health system is the main buyer of hearing aids in Brazil, with 70% of the market share. Approximately 70,000 people received 120,000 hearing aids in 2007, according to data from the National Policy of Hearing Health Care. Hearing aids are generally fit bilaterally, with selection based on audiological data and the needs of the patient. Both behind-the-ear and in-the-ear models are available.
Despite a policy that offers universal services, a large number of hearing aid candidates have not yet received services because there is a limited national budget for hearing aids; when the funds run out, people must wait to receive hearing aids or purchase them in the private sector. Although 70% of hearing aids are government-purchased, the remaining 30% are sold through the private sector. The advantages of the private sector include more hearing aid options, greater ease in obtaining an appointment with less waiting time, and freedom to select a health care provider.
The co-existence of the public and private sectors creates a situation in which the more affluent can afford private services, while the majority of Brazilians use government-sector services. The good news, however, is that patient care outcomes in the public and private sectors are very similar. In short, the Brazilian universal health care system clearly demonstrates that public health programs can be very successful if properly implemented and monitored.
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December 2008
Volume 13, Issue 17