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Twenty years has passed since the Brazilian Sistema Único de Saúde (Unified Health System or SUS) was formally established by the 1988 Constitution. The SUS reform established health as a fundamental right and duty of the state, and started a process of fundamentally transforming Brazil's health system to achieve this goal. What has been achieved to date, and what challenges remain in achieving the goals that were established in 1988? With the demands and expectations on the health system growing rapidly as a result of demographic, economic and social changes in the country, this book addresses two main questions. First, have the SUS reforms managed to transform the health system as envisaged 20 years ago? Second, have the reforms to date led to improved outcomes in terms of access to services, financial protection, and health outcomes?