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Outpatient, Hospital & SUS Procedure Data

The North of the country has a third of the hospital beds and less than half the doctors per capita of the Southeast — a public health system that changes size depending on your zip code.

The National Registry of Health Establishments (CNES), run by the Ministry of Health, records every health facility, professional and piece of equipment in the country, month by month, at municipal granularity. It's the most complete portrait that exists of Brazil's health infrastructure — and what it shows is a unified health system that, in practice, functions as two parallel systems: one well-equipped, concentrated in the capitals of the South and Southeast, and another precarious, scattered across the interior and the North of the country.

Types of health facilities in Brazil

Basic health units, classified as Type 22 in CNES records, account for 42% of all registered facilities in the country — by far the most numerous category. Higher-complexity facilities, capable of performing specialized procedures, appear in a much smaller proportion. The base of the care pyramid is numerically robust; the top, where the most serious cases get resolved, is scarce.

Most registrations in the country are basic health units — but high-complexity care, where the most serious cases are treated, remains scarce.

Facilities by administrative sphere

A significant number of health facilities — more than 15 million records — appear in CNES with no legal-entity information filled in. This data gap makes it harder to trace who actually runs each unit: whether it's a municipality, a state, a philanthropic entity or a private operator. Without this basic information, it becomes harder to hold management accountable.

Millions of health facilities don't even have their legal entity registered — a gap that makes any serious audit of who runs what difficult.

Health coverage by region

The Southeast concentrates the largest share of health facilities in the country and serves 43% of the national population from that base. The North and Center-West are each left with just 8% of the population served by a proportionally smaller structure — the distribution of health infrastructure closely tracks the distribution of wealth and urban density in the country, leaving entire regions with structure disproportionate to the size of their population.

The North and Center-West have less health structure proportional to their population size — the country's health map follows the wealth map.

SUS vs. private: dualization of the system

Seventy-five percent of the Brazilian population depends exclusively on SUS, the public health system; the rest has access to private supplementary healthcare. Per-capita spending in the public system is low compared to the private one, and perceived quality among users varies — generally rated higher in the private system. In practice, Brazil operates two parallel health systems: one universal and underfunded, the other restricted and better funded.

Brazil has two parallel health systems — one for the majority, underfunded, and another for those who can pay, better equipped. Inequality institutionalized by design.

Health deserts: equipment concentration

CT scanners are concentrated in state capitals; MRI machines mainly in São Paulo, Rio de Janeiro and Minas Gerais; and radiotherapy centers are rare even in the capitals of smaller states. To access this equipment, patients from the interior often need to travel hundreds of kilometers to a larger urban center — a travel cost that, in practice, functions as an additional access barrier.

Patients from the interior have to travel to urban centers just to access routine exams available in larger cities — geographic distance becomes a barrier to health access.

Beds per 1,000 population: the gap

Rio de Janeiro has 4.2 hospital beds per thousand population, above the World Health Organization's recommendation of 3.0. The North of the country has just 1.2 — a third of Rio's figure, and well below the WHO recommendation. The Northeast also falls short of the recommendation, with 1.8 beds per thousand population. The regional inequality in hospital beds is one of the most direct indicators of how SUS changes size depending on where you live.

The North has a third of Rio de Janeiro's hospital beds per capita — a health desert institutionalized for decades.

Health professionals: doctors by region

The Southeast has 2.8 doctors per thousand population, with 55% of them specialists. The North has just 1.1 doctors per thousand population — two and a half times fewer than the Southeast — and among those practicing there, only 25% have any specialization. The shortage isn't just quantity: it's also qualification, which further limits the resolving power of the care offered to the population of the North.

The North has two and a half times fewer doctors per capita than the Southeast — and the ones who are there are, for the most part, less specialized.

SIA: high-complexity procedures

Eighty-five percent of the country's chemotherapy treatments are performed in São Paulo, Rio de Janeiro and Minas Gerais. Radiotherapy: 75% in state capitals. Transplants: 90% concentrated in state capitals. High-complexity healthcare in Brazil is, in practice, a privilege for those who live near a major urban center — SUS, in this respect, is less a national system and more a geography of unequal access.

High-complexity healthcare is a privilege for those who live in state capitals — SUS, in this respect, is more a matter of geography than a universal right.

Medications: access and shortages

Only 40% of the Brazilian population has free access to medications through SUS. The other 60% need to pay out of pocket, even though they have a formal right to free access — because 30% of basic health units report recurring shortages of essential items. The popular pharmacy program exists in 80% of municipalities, but that doesn't solve the problem of continuous supply at SUS units.

Sixty percent of the population has no free access to medications and ends up paying out of pocket for what should be a right guaranteed by SUS.

Ambulatory-care-sensitive hospitalizations (ACSH)

Uncontrolled asthma, pneumonia, diabetes and hypertension account for significant shares of hospital admissions in the country — between 25% and 40%, depending on the condition. These are, by definition, preventable hospitalizations: if the patient had had regular access to quality primary care, the condition wouldn't have worsened to the point of requiring hospitalization.

Between 30% and 40% of these hospitalizations would be preventable with quality primary care — the hospital is treating what the health post should have resolved before.

Seven in ten public hospital admissions are emergencies

Hospital admission authorisations record, for each of the 6.6 million admissions in 2025, whether the patient entered through emergency or via a scheduled procedure. The result describes a system operating reactively: 72.1% of admissions are urgent and only 27.4% elective. The proportion matters because elective admission is generally cheaper, more predictable and associated with better outcomes — it means the problem was detected and treated before becoming a crisis. A network with three quarters of entries through emergency indicates primary care is not intercepting conditions in time, and that hospitals end up absorbing demand that should have been resolved earlier, or at least scheduled.

Only one in four public hospital admissions is scheduled — the rest arrive through emergency, once the problem has already become a crisis.

The network reaches more people and vaccinates far fewer

IEPS indicators allow separating two things usually treated as one: how far the system reaches the population and how much it actually delivers. Between 2013 and 2021, Family Health Strategy coverage rose from 84.2% to 89.0% of municipalities — reach improved. Over the same period, vaccination coverage collapsed: polio fell from 93.8% to 77.8%, measles-mumps-rubella from 95.5% to 79.9% and pentavalent from 92.7% to 78.4%. Since the network that administers vaccines is exactly the one that expanded, the drop cannot be explained by lack of access. The herd immunity threshold for these diseases sits around 95%: Brazil was at it in 2013 and left it.

Family Health coverage grew 5 points while polio vaccination fell 16 — the problem is not reaching the population, it is delivering once there.

White patients receive high-complexity care at 1.6 times the rate of Black patients

Public outpatient production records the complexity of each procedure and the patient's colour or race. Two caveats before the number, because they define what it can say: the race field was poorly filled until recently — 18.9% in 2008 — and only became usable lately, reaching 85.2% in 2023, 89.4% in 2024 and 90.5% in 2025. The analysis below is therefore restricted to 2023-2025, a period in which 1.51 billion procedures carry a declared race. Within it, the pattern is consistent: 15.2% of procedures performed on white patients are high complexity, against 11.1% for mixed-race and 9.4% for Black patients — a ratio of 1.61 between white and Black. Asian-descent (5.4%) and Indigenous (4.7%) patients appear lower still, though the Indigenous base is small (1.9 million procedures).

Across 1.5 billion procedures with declared race, a white patient is 61% more likely to receive a high-complexity procedure than a Black patient.

Explanatory hypotheses

The concentration of high-complexity equipment reflects market logic: investment goes where there's paying demand, which naturally favors major urban centers. Dualism theory in healthcare explains the coexistence of two parallel systems — one public, aimed at the majority of the population, and another private, aimed at the middle and upper classes. Chronic SUS underfunding creates a vicious circle: fewer resources result in worse perceived quality, which pushes those who can afford it toward the private sector, further eroding political support for public funding. And the North's sanitary desertification is the legacy of historical abandonment: regions left behind in other public policies systematically receive less investment in health as well.

Policy implications

Regionalizing specialized services, with reference centers distributed across more regions, can reduce the health deserts currently concentrated in the North and the interior. Adequately funding SUS, in a stable way not subject to annual cuts, tends to improve perceived quality and reduce flight to the private sector. Regulating the private health sector more rigorously can reduce its geographic concentration and expand access where it's currently scarce. Programs to bring doctors to the interior — with more medical-school seats outside major centers and incentives to stay there — can reduce the professional gap between regions. And investing in domestic drug production, via Fiocruz and the Butantan Institute, can guarantee more stable access and reduce external dependence.