Federalism and the Brazilian Unified Health System: an integrative literature review

The term federalism and its derivatives have attracted the interest of teachers and students who are militant supporters of the Sistema Único de Saúde (SUS) – the Brazilian Unified Health System, in their teaching, research and extension activities. In organic debates, it has been questioned whether, and to what extent, the Brazilian federalist culture has participated in creating obstacles to the guarantee of health as a right for all citizens. This integrative literature review examines the academic production on federalism during the period from 2015 to 2017, by presenting its main theoretical, conceptual and methodological approaches in its relationship with the SUS. Out of the 238 publications identified, indexed in four health-related databases, 42 complete articles were selected, based on the linked keywords and on the inclusion/exclusion criteria. The articles were grouped into two thematic units: Regionalization of the SUS and Regional Development from the federalist perspective; and Federalism and Healthcare Federalism in Brazil: some remarks. It has observed that the Brazilian federalist culture has ambiguous and controversial traits that are expressed in healthcare federalism by means of multiple directionalities, due to a concrete lack of definition of its starting point. New expressions of society are envisaged as an historical need.