Work

Geographic accessibility and access to hospital services in Brazil’s Unified Health System

Year: 2026

Type: article

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 minutes of a hospital, only 54% 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.

Source: SSM - Health Systems

DOI: 10.1016/j.ssmhs.2026.100318

Authors: Sebastian Bauhoff, Laura Goyeneche

Institution: Inter-American Development Bank

Language: English

Topic: Healthcare Systems and Practices

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDGs: Reduced inequalities, Good health and well-being, Industry, innovation and infrastructure, Sustainable cities and communities

Open Access status: gold

Estimated APC paid: $1,490