Brazil

The Brazilian constitution enshrines the human right to health, which is upheld via its universal, state-run health care system, which is free at the point of use for most procedures. In reality, however, this constitutional obligation places enormous strains on the resources of the health care system, and shortages, rationing and inequitable access are common. Hospitals have tended to lose out to primary care provision in the competition for funding: a World Bank study ('Hospital Performance in Brazil: The Search for Excellence' by La Forgia and Couttolenc) found most hospitals to be 'substandard' and deliver 'inefficient, poor-quality care'.

The pharmaceutical manufacturing industry in Brazil has grown rapidly in the past few years, which has been nurtured by the government. Brazil's ambivalent attitude towards intellectual property rights has resulted in the local industry being overwhelmingly generics-based, with little innovative activity.

The government intervenes regularly in the pharmaceutical market via price controls and threats of compulsory licensing. According to research by Ernst and Young, government levies add 23% to the manufacturers' price. Diabetes sufferers are hit particularly hard by 14% tariffs on imported products containing insulin. Antibiotics, the single biggest class of pharmaceutical import into Brazil, attract tariffs of around 6%.