Conexões entre o federalismo fiscal e o financiamento da política de saúde no Brasil

Abstract

In the Brazilian society's context of meager financial resources for health care, associated with structural features of fiscal federalism and with the current model of funding transfers for the Unified Health System's (SUS), important inequities directly impact political negotiations and the deployment of federal financing alternatives which are not directly linked to the supply and production of health care activities and services by states and municipalities. We observed that health policies, since the second half of the nineties, have developed their own mechanisms that, in the above mentioned context, tend to accommodate different interests and federative conflicts generated by structural factors and by institutional rules. However, the absence of an integrated planning program between the criteria to establish resource redistribution for financing the Unified Health System and the Brazilian Federation's fiscal sharing system, end up reinforcing certain asymmetric patterns and generating new imbalances, making the compensation of inequities difficult in public health spending at the sub-national domain.

Os municípios brasileiros e os gastos próprios com saúde: algumas associações

“…However, if successful adhesion to recent policies meant largely incorporating new sources of revenue to already dependent local governments, the other paradoxically brought them to bear even more substantially with the financial sector [7][8][9] . This has occurred under circumstances of instability and uncertainty regarding public funding not being remedied 10,11 .…”

A crise do federalismo cooperativo nas políticas de saúde no Brasil

“…Aspects directly related to fiscal federalism and demonstrating their effects on regional inequalities and as an opportunity for equitable reform are brought to the political debate (DAIN et al, 2001;LIMA, 2007). Innumerable experiences of regional cooperation, however, are perceived and analyzed as successful cases of health districts and formulation of policies oriented to the consolidation of the decentralized model (MENDES, 1993).…”

Análise da Judicialização do Direito à Saúde, Subfinanciamento do setor e Políticas Públicas: Estudo de Caso no Estado de Alagoas

“…(CONASS, 2011;Santo, Fernando, & Bezerra, 2012;Lima, 2007). No que se refere à avaliação das políticas públicas, a tendência é examinar os aspectos relacionados à eficiência, eficácia e efetividade, apontando a causalidade entre os resultados alcançados e o desempenho de determinada política.…”