Abstract
This study aimed to analyze part of the financial resources used to fund public health actions in the 26-Brazilian capitals, from 2008 to 2018. This is a time-trend ecological study involving revenue and expenditure indicators provided by the Information System on Public Budget for Health (SIOPS). The values were deflated based on the Extended National Consumer Price Index of 2018 in Brazil to allow the comparison over the years. The mean annual variation of health investments, in Brazilian Reais (BRL) was assessed using linear regressions. Pearson's correlation coefficients were estimated between federal revenues and expenditures with the capitals' resources. All capitals presented statistically significant positive correlations for the origin of the budget resource invested in health. The lowest coefficient was found in the capital city of Macapá (Amapá State) (r = 0.860) and the highest, in Fortaleza (Ceará State) (r = 0.997). Belo Horizonte (Minas Gerais State) was the capital with the highest annual increase in federal transfers (about BRL 67.91 per year) and Teresina (Piauí State) presented the highest annual increase in health expenditures among the capitals (about BRL 55.42 per year). We found a increase in the transfers of the Brazilian Unified National Health System (SUS) and municipal resources in almost all capitals, but there are still inequalities in the distribution of financial resources among Brazilian capitals from different regions. Health funding is affected by the municipalization of SUS and it is not the single factor affecting the access and quality of health services.
Highlights
In the light of the Brazilian health reform movement, the Brazilian Unified National Health System (SUS) was created aiming at universalizing health, which is understood as a civil right and a duty of the State 1,2
Regarding health expenditures paid with the municipal resources, in 2008, Salvador (Bahia State) was the capital with the lowest expenditures per inhabitant (BRL 44.80), whereas Vitória (Espírito Santo State) had the highest expenditures (BRL 219.89) (Figure 1b)
In 2018, the lowest per capita expenditures were found in Macapá (BRL 120.17) and the highest in Teresina (Piauí State) (BRL 655.08)
Summary
In the light of the Brazilian health reform movement, the Brazilian Unified National Health System (SUS) was created aiming at universalizing health, which is understood as a civil right and a duty of the State 1,2. To fund the national health policy in Brazil, it was defined that SUS’s financial resources would originate from the budgets of social security and federal, state, and municipal governments, as well as other sources granted by law 3. SUS funding derives from different budget sources, the history of SUS is still marked by insufficient funding 4. The composition of the total resources shared between federal, state, and municipal governments composes a funding system with criteria that are still not sufficiently established 5. Ensuring universal, integral, and good quality public health to Brazilian citizens is a challenge 4,12
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