Geographic accessibility and access to hospital services in Brazil’s Unified Health System
- 1Correspondence to: Principal Health Economist, Health, Nutrition and Population Division, Inter-American Development Bank, 1300 New York Ave NW, Washington, DC 20577, USA.
- 2Health Nutrition and Population Division, Inter-American Development Bank, Washington, DC, USA
Abstract
Geographic accessibility—typically defined by travel distance or time—remains the dominant measure of healthcare access, but it overlooks the institutional conditions that determine whether proximity leads to care. Using Brazil’s Unified Health System (SUS) as a case, we examine how hospital availability, accommodation, and quality mediate effective access. We combined administrative data for the universe of SUS hospitals in 2023 with high-resolution spatial and socioeconomic information to estimate accessibility at multiple travel thresholds and to simulate how improvements in each dimension would affect poor and non-poor populations. Although 85% of Brazilians live within 30 min of a hospital, only 57% can reach one that meets standards for capacity, 24/7 operation, and quality of care. Access shortfalls are largest for specialized services and among poorer populations. Simulations show that improving hospital quality and availability yields the largest and most equitable gains. These findings suggest that effective access depends less on geography than on institutional capability through uneven distribution of resources and service performance.
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BibTeX
@article{bauhoff2026geographic,
title = {{Geographic accessibility and access to hospital services in Brazil’s Unified Health System}},
author = {Sebastian Bauhoff and Laura Goyeneche},
journal = {SSM - Health Systems},
year = {2026},
month = oct,
doi = {10.1016/j.ssmhs.2026.100318},
url = {https://doi.org/10.1016/j.ssmhs.2026.100318},
note = {CC BY},
}
RIS
TY - JOUR
TI - Geographic accessibility and access to hospital services in Brazil’s Unified Health System
AU - Sebastian Bauhoff
AU - Laura Goyeneche
PY - 2026
DA - 2026/10/31
JO - SSM - Health Systems
DO - 10.1016/j.ssmhs.2026.100318
UR - https://doi.org/10.1016/j.ssmhs.2026.100318
AB - Geographic accessibility—typically defined by travel distance or time—remains the dominant measure of healthcare access, but it overlooks the institutional conditions that determine whether proximity leads to care. Using Brazil’s Unified Health System (SUS) as a case, we examine how hospital availability, accommodation, and quality mediate effective access. We combined administrative data for the universe of SUS hospitals in 2023 with high-resolution spatial and socioeconomic information to estimate accessibility at multiple travel thresholds and to simulate how improvements in each dimension would affect poor and non-poor populations. Although 85% of Brazilians live within 30 min of a hospital, only 57% can reach one that meets standards for capacity, 24/7 operation, and quality of care. Access shortfalls are largest for specialized services and among poorer populations. Simulations show that improving hospital quality and availability yields the largest and most equitable gains. These findings suggest that effective access depends less on geography than on institutional capability through uneven distribution of resources and service performance.
SN - 2949-8562
ER -