the population with sufficient income to affordhealth insurance costs are concentrated, it is necessary to gradually implementPPP contracts in which the service users have the possibility of becomingshareholders of investment funds created by financial institutions. Such anarrangement arises from an under-financed system, generated by the inefficiencyof its management. This specific issue is analyzed by Rafael Andreazza Daros[7],who points out the following remarks regarding the Brazilian Unified HealthSystem (SUS):The waythe system is financed impoverishes precisely those whom it seeks to help andbrings down the quality of the service, once the money available for eachtreatment becomes scarcer each time a patient is taken care of. Even worse,regulations to prevent the exodus of doctors to the private system hindercompetition and make treatments more expensive. Anotherharmful effect of all that paternalism is the destruction of the stimulus tocharity, sense of citizenship and responsibility of citizens. Through asystem in which users are encouraged to contribute with accessible cost, aswell as the possibility of monitoring, controlling and participating inmanagement, it becomes possible to keep establishments managed by medicalsocieties with the support of philanthropic entities, in public-privatepartnership contracts structured in accordance with the aforementionedclassification. Due to the transfer of public assets to these establishments,they must provide medical assistance services to low income population, incooperation with the network of existing public establishments in the locality.Everymedical institution of the country should stimulate the use of the NationalHealth Card for an adequate monitoring system. The goal is to extend this card tousers of health plans so that the system can identify the status of eachpatient, with a view to efficiency related to the compensation for privateinstitutions with regard to services provided to the public health systemusers. It is possible to create a health system in which healthy practices andhealth campaigns are encouraged, if the population becomes aware of the costsof the services provided and has the option to become user of affordable healthplans, enabling the targeting of public investment in health care to regions ofthe country in which it is indispensable. In case itis possible to overcome the challenges represented by pressing issues such asthe obstacle of double taxation and the possibility to confer tax immunity tocharities in the context of PPPs, there will be mechanisms to target the long-termachievement of an efficient system of universal health care, whose model can beapplied in other countries or development contexts. Moreover, risk allocationwill be better targeted after the analysis of the achievements during thecontracts life-cycle. [1] LeiNo. 11.079, de 30 de dezembro de 2004, D.O.U. 31.12.2004 (Brazil).[2] Tomas Anker & Bruno Ramos Pereira, O atual cenario das PPPs no setor de saude publica no Brasil:potencialidades, desafios e as primeiras experiencias em ambito estadual [Thecurrent scenario of PPPs in the public health sector in Brazil: opportunities,challenges and early experiences statewide], in Parceriaspublico-privadas: experiencias, desafios e propostas[Public-private partnerships: experiences, challenges andproposals] 163 (LTC eds. 2013)(authors translation) passim.[3] Id. at 174 (authors translation). [4] Suburb Hospital in Salvador-Bahia, n.d. photograph, viewed Jun. 18,2015 http://www.desenbahia.ba.gov.br/Noticias_Ultimas_Noticias_02.aspx?id=2218.[5] Jose Fucs, Em Salvador, um hospital publico que pareceprivado [In Salvador, a public hospital that looks like a private one], available athttp://epoca.globo.com/tempo/noticia/2014/04/em-salvador-um-bhospital-publicob-que-parece-privado.html(last visited