MUCH BEYOND THE MINIMUM why do brazilian municipalities overallocate their own revenues to healthcare?

Abstract

This article identifies reasons for Brazilian municipalities overallocating their own revenues to healthcare which, since the promulgation of Constitutional Amendment 29/2000, have progressively expanded them until they far exceed the constitutional minimum. Linear regression models with mixed panel effects were used for the period of 2008-2017. The tested hypotheses are related to the effects of the population scale of the municipalities; the level of economic and social development of the region in which they operate; the degree of incorporation of technological resources of medium and high complexity; the effort spent on basic care; political guidance from municipal governments; and, finally, to allocation to other budgetary functions and sub-functions of interest to healthcare. The results point to two factors which better explain the dependent variable: the population scale in inverse relation, and the concentration of greater technologically complex services in a direct relation.

Provision of specialized care in remote rural municipalities in Brazil: challenges for local managers

“…managers and exposes them to the deregulated market game -in price, quantity, and quality of the product offered -signaling scal inequities. 26,27 The historical absence of the social policies in rural territories. 15,28,29 has made them hostages to all sorts of exploitation as clients 30 and selective programs aimed at appeasing speci c problems without, however, reversing persistent inequalities.…”

Challenges to the provision of specialized care in remote rural municipalities in Brazil

“…However, these are tiny and poor municipalities, which means that spending health care directly with private providers with own revenues of the municipal treasury reduces the bargaining power of public managers and exposes them to the deregulated market game – in price, quantity, and quality of the product offered – signaling fiscal inequalities [ 39 , 40 ].…”