Sustentabilidade financeira e econômica do gasto público em saúde no nível municipal: reflexões a partir de dados de municípios mato-grossenses

João Henrique Gurtler Scatena,Ana Luiza D'Ávila Viana,Oswaldo Yoshimi Tanaka

doi:10.1590/s0102-311x2009001100013

Abstract

Brazil's Unified National Health System is financed according to a model known as fiscal federalism, the fund-sharing rules of the Social Security Budget, Ministry of Health norms, and Constitutional Amendment 29 (EC-29), which links Federal, State, and municipal resources to health. This article discusses the sustainability of public spending on health at the municipal level. Twenty-one municipalities were studied, using municipal budget data. From 1996 to 2006, total current per capita revenues increased by 280% above the accumulated inflation and Gross Domestic Product, varying by size of municipality, which also defined the composition of the municipal budgets. Meanwhile, the budget comprising the basis for EC-29 increased less (178%), thus placing limits on the municipal share of health spending. The results observed in these municipalities are believed to reflect the reality in thousands of other Brazilian municipalities, thus jeopardizing the capacity for municipal investment in health, especially beginning in 2008. The situation may become even worse, considering the repeal of the so-called Bank Transaction Tax (CPMF), Bills of Law 306/08 and 233/08 (currently under review in the National Congress), and the world recession stemming from the U.S. financial crisis.

Highlights

Brazil’s Unified National Health System is financed according to a model known as fiscal federalism, the fund-sharing rules of the Social Security Budget, Ministry of Health norms, and Constitutional Amendment 29 (EC-29), which links Federal, State, and municipal resources to health
From 1996 to 2006, total current per capita revenues increased by 280% above the accumulated inflation and Gross Domestic Product, varying by size of municipality, which defined the composition of the municipal budgets
The situation may become even worse, considering the repeal of the so-called Bank Transaction Tax (CPMF), Bills of Law 306/08 and 233/08, and the world recession stemming from the U.S financial crisis

Summary

Material e método

O Estado de Mato Grosso, segundo a contagem populacional de 2007, tem uma população de 2.854.642 habitantes, distribuída em 141 municípios, a maioria com menos de 20 mil habitantes (81%) e em Gestão Plena da Atenção Básica – GPAB (93,6%). Como fontes de dados de receitas correntes foram utilizados: (a) balanços municipais, referentes a 1995-1998, consultados nas Secretarias de Finanças/Planejamento e/ou Câmaras Municipais de Vereadores dos municípios do estudo 25; (b) balanços municipais consultados no Tribunal de Contas do Estado, relativos a 1999, e planilhas preenchidas por técnicos deste órgão, relativas aos balanços de 2000; (c) planilhas de Figura 1 Composição do orçamento municipal, segundo origem das receitas. As duas outras fontes completaram os orçamentos municipais numa dinâmica própria: as receitas municipais tiveram baixo peso percentual nos municípios pequenos e foram crescendo à medida que aumentou o porte – e a capacidade de arrecadação – destas unidades, atingindo quase 1/3 do orçamento da capital; de forma inversa e complementar, as transferências federais representaram percentuais elevados nos municípios pequenos e decresceram até os 29,3% observados em Cuiabá, Mato Grosso.

Município Estado União

Pequenos Médios Grandes Capital

Findings

Considerações finais