Primary health care financing changes in the Brazilian Health System: advance ou setback?

Adriano Massuda

doi:10.1590/1413-81232020254.01022020

Abstract

In 2019, the Brazilian government launched a new Primary Health Care (PHC) policy for the Unified Health System (SUS). Called "PrevineBrasil", the policy changed the PHC funding for municipalities. Instead of inhabitants and Family Health Strategy (ESF) teams, intergovernmental transfers are calculated from the number of people registered in PHC services and the results achieved in a selected group of indicators. The changes will have a set of impacts for the SUS and the health of the population, which must be observed and monitored. In this paper, possible effects of the new policy are discussed from a brief context analysis of global trends in health systems financing and health services' remuneration models, as well as on the advances, challenges, and threats to PHC and the SUS. Based on the analysis, the new policy seems to have a restrictive purpose, which should limit universality, increase distortions in financing and induce the focus of PHC actions on the SUS, contributing to the reversal of historic achievements in reducing health inequalities in Brazil.

Highlights

Financing models for health systems and payment for health services are widely debated topics in global health due to the increased sector costs
At a recent United Nations high-level meeting on Universal Health Coverage – one of the Sustainable Development Goals (SDGs) – a resolution that emphasizes the need for countries to ensure sufficient public funding to strengthen health systems, maximize health expenditure efficiency to provide accessible, timely and quality services, and increase the allocation of resources for Primary Health Care (PHC), a pillar for achieving the health-related SDGs1, was adopted
This paper discusses the possible effects of the new policy from a brief analysis of the context of global trends in the financing of health systems and remuneration for health services, as well as the advances, challenges, and threats to PHC and SUS in Brazil

Summary

Introduction

Financing models for health systems and payment for health services are widely debated topics in global health due to the increased sector costs. Both have a robust inductive power on how to organize access to services and technologies, use of available resources, with impacts on health outcomes. This paper discusses the possible effects of the new policy from a brief analysis of the context of global trends in the financing of health systems and remuneration for health services, as well as the advances, challenges, and threats to PHC and SUS in Brazil

Financing of health systems and payment for health services

Advances and challenges of primary health care in the SUS

Possible impacts of the new PHC financing

Findings

Conclusion