Financiamento da saúde e dependência fiscal dos municípios brasileiros entre 2004 e 2019

Cruz, Walter Gabriel Neves; Barros, Rafael Damasceno de; Souza, Luís Eugênio de

doi:10.1590/1413-81232022276.15062021

Cited by 8 publications

(2 citation statements)

References 12 publications

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“…Still about how intergovernmental transfers and municipal resources differ in terms of the response to economic fluctuation, the findings of Cruz, Barros and Souza (2022) somehow complement the evidence provided here. The authors found that the fiscal dependence of Brazilian municipalities regarding the financing of public health services, given by the increase in intergovernmental transfers, increased after the economic recession.…”

Section: Discussionsupporting

confidence: 76%

“…The results indicate that the most populous municipalities show a more pro-cyclical behavior than the smallest municipalities. This difference is more pronounced for municipal health resources than for intergovernmental health transfers, which may be related to the fact that smaller municipalities are in a process of increasing both fiscal and health financing dependence on intergovernmental transfers (Cruz, Barros and Souza, 2022).…”

Section: Discussionmentioning

confidence: 97%

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Economic Fluctuation and Public Health Financing in Brazil

Matosinhos¹

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The Brazilian public health system, officially known as Sistema Único de Saúde (SUS), has long been characterized by insufficient funding and irregular flow of resources. The system is jointly financed by the federal, state and municipal governments, but some imbalance is observed as tax revenue is concentrated at the federal level, while health services are mainly provided at the municipality level. The mismatch between financing capacity and the provision of public health services can influence the financial resilience of SUS in the face of external shocks, such as the economic recession that affected Brazil in 2015-2016. In this sense, the present study investigated the relationship between economic fluctuation and public health financing in Brazil. Specifically, three separate yet complementary articles were developed. In the first article, the scientific production on public health and the 2015-2016 economic recession in Brazil was systematically reviewed, revealing a possible gap in the literature due to the lack of applied studies focusing on the influence of the 2015-2016 economic recession on the financing of public health services in Brazil. In the second article, a trend analysis was carried out to evaluate the financial resilience of the SUS to the 2015-2016 economic recession and the results indicate that the crisis may have negatively influenced the evolution of public health financing in most of Brazilian municipalities. In the third and last article, the use of an instrumental variables approach provided evidence that public health financing is pro-cyclical in Brazil. Based on these findings, two main conclusions were made. First, the mismatch between tax revenue and service provision faced by municipalities gives extra importance to intergovernmental health transfers. Second, the pro-cyclical behavior of public health financing may hinder the construction of a financially resilient health system in Brazil. Keywords: Economic Fluctuation. Public Health Financing. Brazil.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 97%

Economic Fluctuation and Public Health Financing in Brazil

Matosinhos¹

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Repasses financeiros para o enfrentamento da COVID-19 na perspectiva de gestores municipais do estado de São Paulo, Brasil

Duarte,

Viana,

Garcia

et al. 2023

Ciênc. saúde coletiva

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Resumo O objetivo do estudo foi identificar a percepção dos gestores municipais sobre os recursos extraordinários e seus usos no enfrentamento à COVID-19. Trata-se de estudo de casos múltiplos, de métodos mistos incorporados. Foram realizadas entrevistas semiestruturadas com seis municípios-caso do estado de São Paulo. Foram analisados dados secundários extraídos de sistemas de informação no período de 2020 a 2022. As distintas realidades municipais em termos populacionais, de gastos em saúde e de acesso aos recursos federais permitiram observar diferentes estratégias de gestão financeira e alocação dos recursos. Além dos recursos extraordinários, foi possível identificar, no período analisado, a presença relevante de repasses por Emendas Parlamentares. No contexto de desfinanciamento do SUS, esses recursos e repasses significaram, em muitos casos, a possibilidade de os gestores organizarem o sistema de saúde municipal segundo seu entendimento das necessidades de saúde e as respostas possíveis a essas necessidades. Evidenciou-se que os recursos para o enfrentamento à COVID-19 foram alocados principalmente na média e alta complexidade e na contratação de empresas privadas.

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Fund transfers for combating COVID-19 from the perspective of municipal managers in São Paulo state, Brazil

Duarte,

Viana,

Garcia

et al. 2023

Ciênc. saúde coletiva

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The study examined municipal managers’ perceptions of extraordinary funding and its use to address COVID-19. In this multiple-case, quantitative and qualitative study, using embedded mixed methods, semi-structured interviews were conducted in six case-municipalities in São Paulo state. Secondary data for 2020 to 2022, drawn from information systems, were analysed. The municipalities differed by population, health expenditures and access to federal funding, making it possible to observe different financial management strategies and resource allocation. In addition to the extraordinary funding, considerable budget transfers were found to have been made by Parliamentary Amendments during the study period. In a context where the national Unified Health System is underfunded, extraordinary funding and budget transfers by Parliamentary Amendments often enabled managers to organise municipal health systems to meet their understanding of health needs and possible responses to those needs. Funding to address COVID-19 was allocated mainly to medium- and high-complexity services and to engaging private companies.

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Financiamento da saúde e dependência fiscal dos municípios brasileiros entre 2004 e 2019

Cited by 8 publications

References 12 publications

Economic Fluctuation and Public Health Financing in Brazil

Economic Fluctuation and Public Health Financing in Brazil

Repasses financeiros para o enfrentamento da COVID-19 na perspectiva de gestores municipais do estado de São Paulo, Brasil

Fund transfers for combating COVID-19 from the perspective of municipal managers in São Paulo state, Brazil

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