Uma análise da progressividade do financiamento do Sistema Único de Saúde (SUS)

Ugá, Maria Alicia Domínguez; Santos, Isabela Soares

doi:10.1590/s0102-311x2006000800008

Cited by 22 publications

(14 citation statements)

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“…However, such gains should be analyzed with caution: as shown in the literature, discussion of the Federal government's redistributive role and equity in health financing 27 ; degrees of progressiveness in taxes that finance health 28 ; and distribution of resources between social groups 29 . In addition, the low levels of Federal investments pose a serious limitation for reducing health inequalities (one of the main purposes of Federal action), given the heterogeneity of health services supply and access in Brazilian territory.…”

Section: Discussionmentioning

confidence: 99%

Federal funding of health policy in Brazil: trends and challenges

2014

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The article analyzes Federal funding of health policy in Brazil in the 2000s, focusing on the Ministry of Health’s budget implementation. Federal spending on health was less unstable between 2000 and 2002 and has expanded since 2006. However, it fluctuated as a share of both the Gross Domestic Product and Gross National Revenue. Federal intergovernmental transfers increased, exceeding 70% in 2007. Meanwhile, the proportion of Federal investments remained low, varying from 3.4% to 6.3%. The highest absolute amount of spending was on specialized outpatient and hospital care. The decade showed a proportionally greater increase in spending on pharmaceutical care. The growing allocation of Federal funds to States in the North and Northeast, especially for primary care and epidemiological surveillance, failed to offset the sharp regional inequalities in per capita Federal spending. The main characteristics of health funding limit Federal health policy governance and pose several challenges for the Brazilian Unified National Health System.

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Section: Discussionmentioning

confidence: 99%

Federal funding of health policy in Brazil: trends and challenges

2014

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“…Such spending reflects problems related to the chacarteristics of the tax system and tax exemptions 42,43 as well as limits in health funding due to the deviations of Social Security resources, instability of funding sources and low investments 22 .…”

Section: Contradictions and Conditioning Factors Of The Health Policymentioning

confidence: 99%

Políticas de saúde no Brasil em tempos contraditórios: caminhos e tropeços na construção de um sistema universal

2017

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Resumo: O artigo analisa a trajetória de condução nacional da política de saúde no Brasil de 1990 a 2016, bem como explora as contradições e os condicionantes da política no período. Observaram-se continuidades e mudanças no contexto, processo e conteúdo da política em cinco diferentes momentos. A análise dos condicionantes da política mostrou que o marco constitucional, os arranjos institucionais e a ação de atores setoriais foram fundamentais para a expansão de programas e serviços públicos, que conferiram materialidade e ampliaram a base de apoio ao Sistema Único de Saúde no âmbito setorial. No entanto, limites histórico-estruturais, legados institucionais e a disputa de projetos para o setor influenciaram a política nacional. A interação desses condicionantes explica as contradições na política do período, por exemplo, no que se refere à inserção da saúde no modelo de desenvolvimento e na Seguridade Social, ao caráter do financiamento e das relações público-privadas em saúde. A ampliação dos serviços públicos ocorreu de forma concomitante ao fortalecimento de segmentos privados, configurando mercados dinâmicos em saúde, que disputam os recursos do Estado e das famílias, restringem a possibilidade de consolidação de um sistema de saúde universal, reiteram a estratificação social e as desigualdades em saúde.

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“…15 While health spending in the United Kingdom, Denmark, and Sweden are 80 percent or more public and financed predominantly by general taxes, in Brazil the public sector contributes only 44 percent to national health spending and is thus comparable to that of the United States. However, the composition of healthsector financing in Brazil is even more unfair than in the United States, because the majority of the private share consists of out-of-pocket spending, some of which is catastrophic in nature.…”

Section: Concluding Commentsmentioning

confidence: 99%

“…This might indicate a progressive tax structure. 13 However, the highest decile (with 46.1 percent of the country's income) is responsible for only 44.1 percent of the tax payments; this decreases the degree of progressivity of public financing. In deciles 4-9, the income-to-payments ratio is very close to proportional.…”

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confidence: 99%

An Analysis Of Equity In Brazilian Health System Financing

Ugá

Santos²

2007

Health Affairs

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Health care in Brazil is financed from many sources-taxes on income, real property, sales of goods and services, and financial transactions; private insurance purchased by households and firms; and out-of-pocket payments by households. Data on household budgets and tax revenues allow the burden of each source except firms' insurance purchases for their employees to be allocated across deciles of adjusted per capita household income, indicating the progressivity or regressivity of each kind of payment. Overall, financing is approximately neutral, with progressive public finance offsetting regressive payments. This last form of finance pushes some households into poverty. [Health Affairs 26, no. 4 (2007): 1017-1028 10.1377/hlthaff.26.4.1017 T o a s s e s s b r a z i l i an h e a lt h s ys t e m f i nan c i n g from an equity perspective, this paper analyzes the burden of health-sector financing (by source of financing) across income deciles of the population, as well as the impact of one source of health financing on income distribution and the degree of progressivity of health financing. We base our notion of equitable health-sector financing on the idea of progressivity, where the burden of financing is inversely related to individual income. 1 The Structure Of Health Financing In BrazilSince the 1970s, a large private hospital sector and substantial private health insurance have arisen in Brazil. The current Brazilian public-sector health system was introduced under the new Federal Constitution (1988), which, inspired by the idea of a national health system, created the Sistema Único de Saúde (SUS, or Unified Health System), whose principles are free and universal access to health care, comprehensiveness, and public financing. The SUS functions across Brazil's three levels of government (central, state, and municipality).Brazil's constitution allows the existence of a private sector in health, so the Brazilian health system is composed of a mix of the public system and the private sector. The function of private health insurance is called "duplicative" by the Organization for Economic Cooperation and Development (OECD) because the services covered are basically the same services that the SUS provides.2 In practice, the statutory system is the public one, and the private sector, which comprises both private voluntary health insurance and private providers, operates alongside the public system. In the private sector, people pay private providers using private health insurance or out-of-pocket payments. Because Brazilian income is concentrated, high-income populations purchase private health insurance more than do those in lower income groups.3 Exhibits 1 and 2 show the composition of financing in the Brazilian health sector. The main source of financing is taxes, which support public spending (44 percent of total health spending). One-third (34 percent) of total health spending is out of pocket; spending for private health insurance accounts for 22 percent. The central government finances most public-...

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Uma análise da progressividade do financiamento do Sistema Único de Saúde (SUS)

Cited by 22 publications

References 3 publications

Federal funding of health policy in Brazil: trends and challenges

Federal funding of health policy in Brazil: trends and challenges

Políticas de saúde no Brasil em tempos contraditórios: caminhos e tropeços na construção de um sistema universal

An Analysis Of Equity In Brazilian Health System Financing

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