Abstract
Using official data from Brazil's Internal Revenue Service, this article estimates health-related federal tax expenditures between 2003 and 2015. The Ministry of Health will thus be able to assess the relevance of these subsidies within a context of gross underfunding of Brazil's public health system. The analysis was built around concepts and theories developed in the fields of political economy and public finance, focusing on policies directed at public funding of the health sector. The results show that tax expenditures associated with health insurance plans was R$12.5 billion in 2015. It is suggested that these resources could be put to better use in public primary care and medium-complexity care services.
Highlights
The 1988 Constitution provides that healthcare is a “duty of the state” and a right of all citizens
According to the letter of the law, this right shall be upheld by the Unified Health System (Sistema Único de Saúde - SUS), which shall respond to the social needs of all individuals regardless of their ability to pay, inclusion in the labor market or health status
Unlike the Beveridge model and similar to the US private model, the Brazilian health system began to work like a duplicated and parallel system in the wake of the privatization of the former health system structured under the National Institute of Medical Care and Social Security (Instituto Nacional de Assistência Médica da Previdência Social – INAMPS)[1]
Summary
The 1988 Constitution provides that healthcare is a “duty of the state” and a right of all citizens. It is not surprising that there is a certain degree of consensus among health policy analysts that the greatest challenges facing the SUS - securing funding for the public subsystem, redefining the public-private interface, and reducing income, power and health inequalities are essentially political[5] This situation sums up the perverse6 “Americanization” of the Brazilian health system, suggesting that it would be appropriate to rethink why it has not been possible to break the structural shackles of this historical heritage[7] and move towards increased SUS funding and strengthening regulatory mechanisms defined by the National Supplementary Health Agency (Agência Nacional de Saúde Suplementar - ANS) and National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária - ANVISA). Tax breaks have played a key role in the economic reproduction of this duplicated and parallel system This issue deserves far greater attention from the government if the aim is to consolidate the SUS while at the same time reducing family and employee spending on private goods and services. We emphasize some considerations to help direct future research given that – in addition to the challenges facing the SUS in the sphere of funding, management and public participation – it appears at first sight that tax breaks do not promote the consolidation of the SUS and equity in Brazil’s health system
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