Topic: Health coverage: who's required to have it, and who actually pays
What does Brazil require?
Everyday topic
Brazil's SUS is grounded in Article 196 of the 1988 Federal Constitution: “health is a right of all and a duty of the State” — put into concrete operation by Law No. 8,080/1990, whose Article 7 lists “universality of access” and “integrality of care” among its principles. Anyone physically present in Brazil, regardless of nationality or immigration status, is entitled to free public healthcare — a 2024 Ministry of Health guideline reaffirms primary-care access for migrants, refugees, and stateless people. On financing, the federal government must spend at least 15% of its net current revenue on health each year under constitutional amendment. SUS coexists with a private insurance market: plans regulated by the national supplementary health agency cover roughly 53 million people, about a quarter of Brazil's 212 million population, but holding a private plan doesn't remove anyone's right to use SUS — a coexistence often called the “double door.”
What is this topic?
Taiwan's National Health Insurance Act declares enrollment mandatory in its very first article, launched in March 1995, with premiums split employer 60%, insured person 30%, government 10%.
Japan closed the last gap in "universal coverage" only in 1961, after a 1958 law forced every municipality to run its own scheme; patient co-payments still scale by age, from 10% at 75-plus to 30% between 6 and 69.
Indonesia's 2004 SJSN Law states outright that "participation is compulsory," and a foreign worker becomes covered after six months on the job — almost the same threshold Taiwan uses.
Brazil's SUS is the direct product of Article 196 of its 1988 Constitution, "health is a right of all and a duty of the State," free to anyone within its borders.
China, by contrast, reports 95% nominal coverage, but its employee and resident schemes reimburse hospital stays at rates 18 points apart — 84.1% versus 66.0%.
India has no universal mandate at all: PM-JAY reaches only the poorest 40% of households, and out-of-pocket spending still runs 43.4% of the total.
The United States is the only one of the seven with no coverage guarantee whatsoever — its federal mandate has existed in name only since 2019, 8.0% of the population remained uninsured in 2024, and it spends more per person on healthcare than any other.
Sources and dates
Dates follow local time zones, calendars, and official notices. Check the source when a date is estimated or locally variable.