responsibilities for providing health care services differ across municipalities depending on their level of development and administrative capacity this arrangement has resulted in greatly heterogeneous levels and quality of services for instance around of the municipalities mostly in the poorest regions do not provide urgent medical care and of them do not have a resident publicsector doctor issa this is an especially important issue in brazil given its continental size and the shortcomings of its transportation network there is evidence that more sophisticated procedures are largely unavailable to more than half of the population without private insurance plans as they mainly are supplied by the private sector only issa