Hans Dohmann explains why the future of the Brazilian Unified Health System (SUS) should focus less on hospitals and more on community development.

The Unified Health System (SUS) currently serves approximately 76% of the Brazilian population, which corresponds to more than 160 million people with direct and free access to healthcare. The volume of services exceeds 2,8 billion per year, distributed among immunizations, consultations, examinations, and various treatments, with primary care playing a central role in the care pathway.

To Hans DohmannAccording to a physician and specialist in health management, this scenario reinforces that the future of the Brazilian Unified Health System (SUS) needs to depend less and less on the traditional hospital model and more and more on territory-based care, focusing on prevention, primary care, and continuous care for people. 

"The Brazilian Unified Health System (SUS) needs to reorganize its care logic. The territory, where people live, work, and are..." "They relate to this, and should be the focus of health actions, with fewer trips to hospitals and more effective solutions within the community," he states.

In this context, the strategic use of digital technologies emerges as a key element to expand the capacity for care in the territory. Tools such as integrated electronic health records, telemonitoring, the use of population data, and care coordination platforms allow for continuous patient monitoring, early identification of risks, and support for clinical decisions without the hospital being the central point of care.

Family Health celebrates 30 years.

One of the main foundations for the territorial operation of the Brazilian Unified Health System (SUS) is the Family Health Strategy (ESF), created in 1994 and celebrating its 30th anniversary as a priority for primary care. The number of Family Health teams grew by almost 18% between 2022 and March 2024, reaching more than 61 teams distributed across more than 47 basic health units throughout the country. 

According to official data, primary healthcare coverage through the Family Health Strategy (ESF) currently reaches almost 80% of the Brazilian population.

The Family Health Strategy (ESF) has a direct impact on the population's health and on reducing inequalities in access, as its teams are embedded in the territories, close to the communities, which fosters the development of bonds with users and allows for continuous actions in health promotion, prevention, diagnosis, and comprehensive care.

Less hospitalization and more continuous care.

Data from epidemiological research and public policy indicate that the expansion of primary care is associated with a reduction in hospitalizations for conditions sensitive to primary care—those that could be prevented or resolved with early and continuous care, such as diabetes, asthma, and circulatory complications. 

An OECD study indicates that the Family Health Strategy was associated with a drop of approximately 45% in standardized hospitalization rates per 10.000 inhabitants between 2001 and 2016, mainly due to conditions that a well-structured primary care system could prevent.

This type of hospitalization represents high costs for the SUS (Brazilian Public Health System). "The logic of territorial care seeks to anticipate health risks within the home and community, retaining people in the territory and reducing the need for urgent and highly complex hospital care, which in turn promotes resource savings and improves the patient experience.", explains the doctor and manager.

Territory, connection, and wholeness

Territorialized primary care involves multidisciplinary teams that work in the daily lives of communities, including doctors, nurses, community health workers, and other professionals, capable of implementing care plans adapted to local needs. This continuous presence favors the early detection of health problems, the monitoring of chronic diseases, and the tracking of risk factors, reducing the chances of decompensation that would require hospitalization.

According to Hans Dohmann, systems with strong primary care not only achieve better results in health indicators, but also demonstrate greater technical efficiency and lower operating costs over time, compared to models predominantly centered on hospitals and highly complex services.

Sustainability and community-centered care

Dohmann also points out that, in order to make the SUS (Brazilian Public Health System) financially sustainable and more socially effective, it is necessary to consolidate a care model that considers the living conditions and social determinants of health present in the territories. 

"The future of the Brazilian Unified Health System (SUS) demands the integration of digital technologies with care practices that are truly rooted in people's lives, reducing dependence on hospitals and strengthening primary and community-based care.", observes.

Expanding community-based care, according to health policy analysts, requires not only investments in the infrastructure of primary health care units, but also professional training, integration of population data, and the promotion of intersectoral actions that address determinants such as housing, education, and employment, which directly influence health outcomes.

About Hans Dohmann

Dohmann is a physician, holds a master's degree in Cardiology from the State University of Rio de Janeiro and a doctorate in Health Sciences from the Federal University of Rio de Janeiro. He conducted stem cell research in partnership with the Texas Heart Institute. Municipal Secretary of Health of Rio de Janeiro between 2009 and 2014 Currently, he works in the areas of population management and digital health in the private sector, serving as medical director at Stone, where he is responsible for the Verde Virtual Hospital.