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Nearly five million Brazilians now live outside the country. At some point, many of them discover something that the health systems of their countries of residence rarely explain: leaving Brazil does not mean losing your connection to Brazilian healthcare.
Every year, Brazilians travel back, temporarily, to receive care. Some come for a diagnosis that would be costly or take months where they live. Others come to maintain an ongoing treatment. Many come for procedures they chose to have here: a plastic surgery, a dental treatment, a protocol they trust to a Brazilian professional. This phenomenon has a name: health return (retorno sanitário), the temporary or recurring travel of Brazilians living abroad, driven mainly by access to health services in their country of origin.
The concept emerged from academic research developed at ENSP/Fiocruz on the Brazilian diaspora and the right to health, and this text presents its practical dimension: what a Brazilian abroad can access in Brazil, with what legal support, and what to do when the care sought here does not go as it should.
The right that does not travel back with you
Brazil’s 1988 Constitution defined health as a right of all and a duty of the State, and the Unified Health System (SUS) was built on the principle of universality. The point most emigrants are unaware of: this bond does not dissolve with a change of address. A Brazilian residing abroad remains a holder of the right to health in Brazil, and, in practice, can be treated by the SUS while on national territory, like any citizen.
This has concrete consequences. An emigrant facing barriers in their country of residence, expensive insurance, restricted eligibility, waiting lists, uncovered treatments, keeps in Brazil a door that never closed. For ongoing treatments, such as those for HIV/AIDS, where Brazil built one of the world’s most recognized access policies, that door can mean the difference between the continuity and the interruption of care.
The agreements few know about: the CDAM
There is also an international layer. Brazil maintains bilateral health cooperation agreements with countries such as Portugal, Italy and Cabo Verde, operationalized through the Certificate of Right to Medical Assistance (CDAM), a document that allows a Brazilian to be treated in the public system of the partner country on terms similar to those of nationals, and vice versa. In Portugal it is known as the PB4, and in Italy as the IB2. For the large Brazilian community in Portugal, for example, knowing this instrument changes the calculation of how and where to seek care.
The return that is also surgical, dental and aesthetic
Health return is not limited to disease treatment. A significant portion of these trips involve elective procedures: plastic surgery, dental treatment, aesthetic protocols. The reasons are familiar to those who live abroad: cost, language, the family network that supports recovery, and confidence in Brazilian technique in specialties where the country is a reference.
These trips are a legitimate exercise of the right to health. But they carry a dimension almost no one discusses before boarding: when something goes wrong, distance becomes part of the problem.
When care fails and the patient has already returned
Picture the scenario, which is more common than statistics show: a Brazilian woman living in London comes to Rio on holiday, has a plastic surgery, and the complication appears three weeks later, when she is already back in London. Who is responsible for the post-operative follow-up? How does she obtain the medical records six thousand kilometres away? How does she challenge the outcome legally without being able to appear in person?
This is the specific vulnerability of the transnational patient: the information asymmetry is greater, post-operative follow-up is more fragile, access to documentation is harder, and the cost of returning to treat the complication, or to seek reparation, adds to the harm itself. It is a real vulnerability, but not a dead end. A few points every patient in this situation should know:
A procedure performed in Brazil is subject to Brazilian law. The liability of the professional and the clinic, the duty to inform about risks, the right to the medical record: all of this applies to a patient residing abroad exactly as it applies to a resident in Brazil, and can be exercised remotely, through representation. The central distinction between error, complication and dissatisfaction that organizes aesthetic-procedure cases applies fully; and the duty of information carries added weight when the professional knew the patient would board within days and could not comply with the recommended follow-up.
Documentation, here, matters even more. For anyone about to travel after a procedure: take with you a copy of the medical record, the exams, the informed-consent form and the discharge instructions before you leave. Document the post-operative period with dated photographs. Keep your conversations with the clinic. The transnational patient who documents protects both their health, the professional who treats them abroad will need this history, and their rights.
Health insurance, medications and the patient who moves between countries
There is also the Brazilian who keeps a Brazilian health plan while living abroad, or who returns and re-contracts one. For them, the discussions covered in our international clients practice apply: coverage denials, high-cost medications, abusive readjustments. Residing abroad does not remove from the Brazilian consumer the protection of Brazilian consumer law over contracts signed here.
A phenomenon invisible in the statistics, and visible in the consulting rooms
The research that gave rise to this concept found something revealing: there is no administrative record in Brazil that captures health return. The thousands of Brazilians who come back to receive care are invisible in official statistics, but perfectly visible in clinics, consulting rooms and, when something fails, in law offices. Naming the phenomenon is the first step for these patients to stop being isolated cases and become what they are: a population with specific rights and specific vulnerabilities, deserving of information worthy of them.
Before concluding
If you live abroad and are planning to seek care in Brazil, inform yourself before you board, about what the SUS offers, about the agreements with your country of residence, about how to document an elective procedure. And if you have already undergone a treatment in Brazil that did not go as it should, distance has not extinguished your rights: it only requires that they be exercised with method. The office is available for a responsible analysis of your situation, including remotely.
About the author
Ramon Martins Andrade (OAB/RJ 188.374) is a lawyer graduated from UFRJ in 2011, holding master’s degrees from the Université Sorbonne Nouvelle and from the Brazilian Naval War College (EGN). He is currently a researcher in Human Rights and Health at ENSP/Fiocruz, where the concept of sanitary return emerged from his research in study groups on the Brazilian diaspora and access to healthcare.
This content is for informational and educational purposes only. It does not constitute legal advice, advertising of results or any guarantee of success in proceedings, under the terms of Provision 205/2021 of the Brazilian Bar Association (OAB).