A methodology for apportioning federal SUS resources: the health needs index

Abstract

OBJECTIVE: To present a methodology for apportioning Union resources to the federative units (FU – 26 states and one federal district) within the Brazilian Unified Health System (SUS) based on health needs measured by demographic, socioeconomic, epidemiological and geographical dimensions. METHODS: The apportionment methodology proposal prioritizes the health needs axis, based on Law 141/2012. We adopted a proxy of needs that measures relative inequalities between, socioeconomic, geographic demographic and epidemiological conditions of the populations of the Brazilian Federative Units (FU) for 2015. We first used an adjustment so that the populations of the 27 FU are corrected by their relative needs regarding age and gender. To calculate the health needs axis, the multivariate techniques factorial analysis and principal components were used, and, based on such correction, we applied the health needs index. Subsequently, this index was applied to simulate the resources that should be transferred by the Ministry of Health to states in 2015. RESULTS: As we made the methodological choice of transferring a single per capita amount to all states, so the proposal required population correction. Thus, in the analysis of health needs, the FUs that had their population corrected by a factor higher than the national average because of their greater relative need, were the states of: Maranhão, Piauí, Alagoas, Paraíba, Ceará, Pará, Bahia, Acre, Pernambuco, Rio Grande do Norte, Sergipe, Amazonas, Tocantins and Roraima. For the simulation aggregating all the financing blocks, without reducing the resources already distributed to the remaining states in 2015, indicated the additional need of R$ 4.6 billion. CONCLUSIONS: The proposal addresses the absence of studies presenting quantitative simulations of federal resources distribution within the scope of SUS to the FUs, based on the apportionment criteria defined by Law 141/2012, in order to contribute to the reduction health inequalities and mitigate the effects of the economic crisis.

Pharmaceutical Services Management Capacity and the Municipal Socioeconomic Scenario: Persistent Inequalities

“…Despite the various strategies to improve PHC nancing and investment in training [18], it is known that Brazilian municipalities face diverse types of di culties, especially small ones, because they do not have enough own resources to nance expenses not covered by the federal government [20,51]. Besides, the health service network is insu cient and there is di culty in maintaining human resources in small municipalities [51,58,59].…”

“…According to national studies, there was a high prevalence of full access to medicines in the country in 2014: more than 47% all medicines prescribed for chronic diseases were accessed through Primary Care centers [14]. However, despite advances, weaknesses in the development of pharmaceutical services persist in the country [15][16][17][18][19][20] strongly related to management capacity [21][22][23].…”