The challenges of funding the Brazilian health system in fighting the COVID-19 pandemic in the context of the federative pact

Abstract

Resumo O aprimoramento das regras de financiamento do Sistema Único de Saúde (SUS) em estados e municípios é um dos grandes desafios da saúde pública no Brasil. O objetivo deste artigo é contribuir para este amplo debate, analisando a resposta governamental ao desafio de combate à COVID-19, sob o prisma do financiamento público dos serviços de saúde dos governos subnacionais brasileiros. Uma abordagem quali-quantitativa é adotada, mesclando-se análise documental e análise de regressão. Resultados mostram que não houve mudança substantiva nos critérios de repasse, pouco sensíveis a fatores epidemiológicos. Ajustes nas normas de aplicação foram realizados para dar maior agilidade aos gastos. Tamanho populacional, produção de riquezas locais e número de leitos de internação parecem ser os principais fatores que definem a distribuição dos recursos. O desenho de financiamento do combate à COVID-19, assim como o volume de recursos parecem ser insuficientes frente à dimensão da crise.

Brazil's health system functionality amidst of the COVID-19 pandemic: An analysis of resilience

“…This restriction was only lifted in mid-April, explaining the increase in hospital beds from April to December ( Figure 2 ). 27 …”

Performance of Subnational Governments in the COVID-19 Pandemic: An Analysis of the Public and Private Health Services in Brazil

“…Therefore, state capacity is a vital element of the Brazilian public health policy, emphasizing the transfer of resources between federal, state, and local governments (Gofen & Lotta, 2021;Segatto et al, 2021). An essential variable in the Brazilian case is the system's (SUS) capacity to respond to the pandemic by allocating financial and human resources and offering infrastructure (e.g., inpatient beds and ventilators) (Castro et al, 2019;Fernandes & Pereira, 2020).…”

“…Initially, it is necessary to understand how the Brazilian government reacted to the pandemic. The low participation of the federal government in intergovernmental coordination made states take on the responsibility of meeting the population's demand for health services (Abrucio et al, 2020;Fernandes & Pereira, 2020;Gofen & Lotta, 2021), a demand that also reached private health service providers (Croda et al, 2020;Moreira, 2020). The scenario presented many phenomena worth researching, such as the process of adopting social distancing measures, vaccination programs, and the elaboration and enactment of norms and decrees to govern the responses to health crises.…”

Did they even try? Brazilian government policy measures in the first 12 weeks of the pandemic

“…Possible alternatives for public management of the consequences of the crisis discussed in the literature include a monetary financing model, which is unlikely to cause inflation because other conditions for inflation are not present in the pandemic setting (Bresser‐Pereira, 2020, pp. 610–617); the use of the state apparatus with “exit strategies” to avoid unjustified state support after the crisis (Lazzarini & Musacchio, 2020), and general demands for more public financing (Fernandes & Pereira, 2020). Authors agree that the management of the pandemic policy problem is costly, but “although using the state apparatus (…) entails a set of risks, not using it may increase the risk of extending the crisis” (Lazzarini & Musacchio, 2020, p. 561).…”