Analysis of financial resources for public health in Brazilian capitals: a time trend ecological study

Abstract

This study aimed to analyze part of the financial resources used to fund public health actions in the 26-Brazilian capitals, from 2008 to 2018. This is a time-trend ecological study involving revenue and expenditure indicators provided by the Information System on Public Budget for Health (SIOPS). The values were deflated based on the Extended National Consumer Price Index of 2018 in Brazil to allow the comparison over the years. The mean annual variation of health investments, in Brazilian Reais (BRL) was assessed using linear regressions. Pearson’s correlation coefficients were estimated between federal revenues and expenditures with the capitals’ resources. All capitals presented statistically significant positive correlations for the origin of the budget resource invested in health. The lowest coefficient was found in the capital city of Macapá (Amapá State) (r = 0.860) and the highest, in Fortaleza (Ceará State) (r = 0.997). Belo Horizonte (Minas Gerais State) was the capital with the highest annual increase in federal transfers (about BRL 67.91 per year) and Teresina (Piauí State) presented the highest annual increase in health expenditures among the capitals (about BRL 55.42 per year). We found a increase in the transfers of the Brazilian Unified National Health System (SUS) and municipal resources in almost all capitals, but there are still inequalities in the distribution of financial resources among Brazilian capitals from different regions. Health funding is affected by the municipalization of SUS and it is not the single factor affecting the access and quality of health services.

Maintenance of medium- and high-complexity health services in the context of high patient transition: a time series ecological study of the state of Rio de Janeiro, Brazil

“…Since the creation of SUS, there has been a process of increasing municipal spending on health and reducing the percentage of federal financing and, consequently, the need to increase resources for health at this level 5,[33][34][35][36] . In this sense, Teles et al 37 , when analyzing the allocation of federal resources in the state of Bahia, found a large concentration of resources allocated to a few municipalities with a large population and with the highest HDI, and a low amount to regions with greater health needs, that is, with greater vulnerability, which increases regional inequity, a cause that may arise from the quality of the service network found in smaller municipalities, similar to the case of Rio de Janeiro.…”

Health inequalities in Brazil: proposed prioritization to achieve the Sustainable Development Goals

“…This study has limitations which are inherent to ecological studies, particularly regarding the use of secondary data in comparisons between HRs, which does not take into account the weaknesses of information systems. Studies indicate significant underreporting differences in information systems regarding the structure of health networks when comparing the regions of the country 47,48,49 . This is particularly relevant in the North Region, with the highest number of underreported diseases, for example, diabetes mellitus and tuberculosis 47 .…”

Manutenção dos serviços de média e alta complexidade em contexto de alta transição de usuários: um estudo ecológico de séries temporais no Estado do Rio de Janeiro, Brasil

“…Desde a criação do SUS, houve um processo de incremento dos gastos municipais em saúde e de redução do percentual no financiamento federal, e consequentemente a necessidade de aumento de recursos para a saúde neste nível 5,[33][34][35][36] . Nesse sentido, Teles et al 37 , ao analisarem a alocação de recursos federais no estado da Bahia, verificaram grande concentração de recursos destinada a poucos municípios de grande porte populacional e com os mais altos IDH, e baixo aporte para regiões com maiores necessidades de saúde, ou seja, com maior vulnerabilidade, o que aumenta a iniquidade regional, que pode ser oriunda da qualidade da rede de serviços encontrada nos municípios menores, semelhante ao caso do Rio de Janeiro.…”