29 92. Article 199 of the Constitution provides that “[h]ealth care is open to the private initiative,” meaning that private institutions can render health care services, which will be fully paid by users. Notwithstanding, the first paragraph of such Article 199 provides that “[p]rivate institutions, among which philanthropic and non-profit organizations will be given priority, may participate in the [S]ingle [H]ealth [S]ystem by rendering health care services as supplementary agents, in accordance with the guidelines laid down by such System and by virtue of a public contract or agreement.” Private institutions may also render services for the public health system, in which case health care will be financed by the State and will be of a public nature. 93. Law No. 8,080 of September 19, 1990 “regulates nationwide health policies, programs, and services provided either independently or jointly, permanently or fortuitously, by public or private natural or artificial persons.” Article 4 of said law defines Brazil´s Single Health System (SUS) as the “set of health policies, programs, and services provided by federal, state* or municipal bodies, as well as by institutions which are directly or indirectly managed by the State and by foundations thereby supported,” and reaffirms the above mentioned constitutional provision when establishing that “[p]rivate institutions may participate in Brazil´s Single Health System as supplementary agents.” 94. From the foregoing it results that in the State system, health care services may be rendered by public bodies or private institutions; in the latter case, the services are private and paid by the patients themselves, but the State keeps its power to supervise them. 95. When health care services are public, it is the State which renders them directly to the population, through its Single Health System. This public health care system is primarily offered at public hospitals; notwithstanding when in a region of the country there are not enough public hospitals to provide health care services to all patients,29 private institutions, as supplementary agents and by virtue of contracts or agreements entered into with the SUS, may also provide health care under the umbrella of the Single Health System. In both cases, whether the patient is admitted into a public hospital or a private institution which operates by virtue of a contract or an agreement entered into with the SUS, the patient is under the care of the Brazilian public health system, that is, of the State. 96. Rendering public services implies the protection of public interests, which is one of the objectives of the State. Though the States may delegate the rendering of such services, through the so-called outsourcing, they continue being responsible for providing such public services and for protecting the public interest concerned. Delegating the performance of such services to private institutions requires as an essential element the responsibility of the States to supervise their performance in order to guarantee the effective protection of the human rights of the individuals under the jurisdiction thereof and the rendering of such services to the population on the basis of non-discrimination and as effectively as possible. * The term “state” refers to the “states” as the political units making up the Brazilian federation. 29 Cf. Article 24 of Law No. 8.080/1990.