Aplicações diretas para aquisição de medicamentos no Sistema Único de Saúde

Abstract

OBJECTIVE:To analyze resource allocation for pharmaceutical procurement by federative entities in the Brazilian Unifi ed Health System. METHODS:The amounts allocated to purchase pharmaceuticals during 2009 in two information systems were analyzed: Siga Brasil (Follow Brazil) for national data and Sistema de Informações sobre Orçamentos Públicos em Saúde (Information System on Public Health Budgets) for states, the Federal District and municipalities data. Per capita spending and the mean and median spending were calculated by municipalities, according to region and population size. The Spearman correlation coeffi cient was calculated for some variables. The statistical analysis included tests of normality and multiple comparisons for differences between groups. RESULTS:In 2009 the total amount spent by the three spheres of government for purchase of medicines was approximately R$ 8.9 billion. States and the Federal District were the main players, accounting for 47.1% of the total amount spent in the health system. Some states had per capita spending well above the mean (R$ 22.00 per resident/year) and the median (R$ 17.00 per resident/year). There were differences in municipal spending by region. The mean per capita expenditure of municipalities with less than 5,000 residents was 3.9 times that of municipalities with over 500,000 residents. Municipalities with less than 10,000 residents had higher per capita spending than other municipalities. CONCLUSIONS:Economic aspects such as the scale of procurement and bargaining power may explain differences in per capita spending between federal entities, especially among municipalities. The study indicates ineffi ciencies in the use of fi nancial resources to procure medicines in the Brazilian Unifi ed Health System.

Trends in medicines procurement by the Brazilian federal government from 2006 to 2013

“…First, SIASG is a national database that registers medicine purchases and does not allow an assessment of dispensed/prescribed medicines at the individual patient level, so the estimates are a proxy for actual consumption. Considering the complexity of the administrative structure for medicine procurement procedures in Brazil, it is presumed that these analyses represent about one third of drug procurement in the country [9, 33], a considerable amount. Additionally, SIASG does not offer any margins or mark-up values, such as distribution margins, service fees etc.…”

“…Besides its complex administrative structure regarding medicines procurement procedures—conducted independently by more than 5,500 municipalities, 26 states and the Federal District, the Federal Government, as well as hospitals under indirect public administration—, a large portion of medicines expenditures is out-of-pocket and most private health insurance plans fail to cover medicines [8]. The analysis of medicines expenditures must be performed, thus, for each public level to identify potential problems and formulate adequate and cost-effective policies [9]. …”

Avaliação normativa do processo de prescrição e dispensação de imunossupressores para pacientes transplantados renais no estado de Minas Gerais, Brasil, 2008

“…21 As análises de gastos consideraram as doses máximas de imunossupressores, uma vez que não foi possível identificar completamente os pacientes transplantados há mais tempo. Esses pacientes tendem a usar doses menores e os valores referentes ao gasto dos medicamentos podem estar superestimados.…”

Financiamento Em Saúde: Análise Da Produção Científica No Período 2007-2013

“…No total, houve aumento de 61,6% no montante de recursos financeiros do SUS para a aquisição de medicamentos (17,26,29) . Este fato corrobora o restante do financiamento da saúde, considerando a descentralização do financiamento público aos estados e municípios, e destaca o aumento de 4,4% da participação estatal na aquisição de medicamentos.…”