Public policies and access to health in Brazil: an integrative review of public and collective health evidence

Abstract

Objective: To analyze how recent scientific evidence characterizes the effects of public policies on access to health care in Brazil. Method: An integrative review was conducted in SciELO and PubMed, covering articles published from 2020 through 2025. Searches combined terms related to public policy, health services accessibility, the Unified Health System, primary health care, inequality, and Brazil. Twelve studies meeting the eligibility criteria were analyzed through thematic synthesis. Results: The evidence indicates that the Unified Health System and the Family Health Strategy remain essential mechanisms for universal access, but formal entitlement does not ensure timely, continuous, or equitable care. Geographic distribution of services, financing rules, workforce composition, race, income, education, disability, and Indigenous status shape the ability to obtain care. Recent changes in primary care financing created incentives for registration and performance, while also raising concerns about unstable transfers, selective indicators, and weakened community orientation. Digital health can reduce distance and improve coordination, but may reproduce exclusion where connectivity and digital literacy are limited. Conclusion: Expanding access requires stable and redistributive financing, territorially based primary care, multidisciplinary teams, accessible infrastructure, anti-racist and culturally appropriate policies, and digital strategies integrated with in-person care. Access should be monitored through availability, first contact, continuity, comprehensiveness, acceptability, and effective use rather than enrollment alone.