Financiamento da saúde e dependência fiscal dos municípios brasileiros entre 2004 e 2019

Cruz, Walter Gabriel Neves; Barros, Rafael Damasceno de; Souza, Luís Eugênio de

doi:10.1590/1413-81232022276.15062021

Cited by 10 publications

(17 citation statements)

References 12 publications

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“…Still about how intergovernmental transfers and municipal resources differ in terms of the response to economic fluctuation, the findings of Cruz, Barros and Souza (2022) somehow complement the evidence provided here. The authors found that the fiscal dependence of Brazilian municipalities regarding the financing of public health services, given by the increase in intergovernmental transfers, increased after the economic recession.…”

Section: Discussionsupporting

confidence: 76%

“…The results indicate that the most populous municipalities show a more pro-cyclical behavior than the smallest municipalities. This difference is more pronounced for municipal health resources than for intergovernmental health transfers, which may be related to the fact that smaller municipalities are in a process of increasing both fiscal and health financing dependence on intergovernmental transfers (Cruz, Barros and Souza, 2022).…”

Section: Discussionmentioning

confidence: 97%

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Economic Fluctuation and Public Health Financing in Brazil

Matosinhos¹

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The Brazilian public health system, officially known as Sistema Único de Saúde (SUS), has long been characterized by insufficient funding and irregular flow of resources. The system is jointly financed by the federal, state and municipal governments, but some imbalance is observed as tax revenue is concentrated at the federal level, while health services are mainly provided at the municipality level. The mismatch between financing capacity and the provision of public health services can influence the financial resilience of SUS in the face of external shocks, such as the economic recession that affected Brazil in 2015-2016. In this sense, the present study investigated the relationship between economic fluctuation and public health financing in Brazil. Specifically, three separate yet complementary articles were developed. In the first article, the scientific production on public health and the 2015-2016 economic recession in Brazil was systematically reviewed, revealing a possible gap in the literature due to the lack of applied studies focusing on the influence of the 2015-2016 economic recession on the financing of public health services in Brazil. In the second article, a trend analysis was carried out to evaluate the financial resilience of the SUS to the 2015-2016 economic recession and the results indicate that the crisis may have negatively influenced the evolution of public health financing in most of Brazilian municipalities. In the third and last article, the use of an instrumental variables approach provided evidence that public health financing is pro-cyclical in Brazil. Based on these findings, two main conclusions were made. First, the mismatch between tax revenue and service provision faced by municipalities gives extra importance to intergovernmental health transfers. Second, the pro-cyclical behavior of public health financing may hinder the construction of a financially resilient health system in Brazil. Keywords: Economic Fluctuation. Public Health Financing. Brazil.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 97%

Economic Fluctuation and Public Health Financing in Brazil

Matosinhos¹

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“…Esse fato foi observado nos últimos anos (2018 e 2019), no qual a participação percentual da receita de impostos próprios no município de Vitória sofreu decréscimo, passando de 54% em 2017 para 52,38% em 2018 e 49,34% em 2019, reduzindo o montante de recursos próprios municipais para execução da política de saúde. Esse movimento pode estar articulado à baixa arrecadação de impostos por parte do município e às oscilações na economia nacional (Cruz;Barros;Souza, 2022).…”

Section: Receita Da Saúde No Município De Vitóriaunclassified

“…Esse resultado pode apontar o aumento da dependência fiscal do município em relação à União. De acordo com Cruz, Barros e Souza (2022), esse panorama de dependência das transferências federais foi "[...] agravado com a aprovação de emendas constitucionais que limitaram a autonomia municipal no desenvolvimento de mecanismos locais de tributação" (Cruz;Barros;Souza, 2022, p. 2.465).…”

Section: Receita Da Saúde No Município De Vitóriaunclassified

The financing of health in Vitória (ES): a look at primary care

França,

Silva,

Zuccolotto

2024

Argum

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Este estudo objetivou analisar as receitas direcionadas às ações e aos serviços de saúde, em particular à atenção básica, no município de Vitória (ES), no período de 2009 a 2019. Trata-se de uma pesquisa documental e quantitativa, que utilizou para análise os indicadores de receitas em saúde do Sistema de Informações sobre Orçamentos Públicos em Saúde. A receita total apresentou média de R$ 5.176,91 por habitante/ano, com o decréscimo (16,52%) na receita disponível. Apesar da ampliação da receita em relação aos impostos próprios, manteve-se a dependência em relação às transferências constitucionais. Houve ainda decréscimo de recursos federais (32,48%) direcionados à atenção básica. Desse modo, o município enfrenta limitações estabelecidas pela dependência fiscal, participação desarmônica entre os entes federativos e redução de recursos públicos federais para a subfunção atenção básica.

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“…In Brazil, a context of fiscal austerity, in place since implementation of the national health service (SUS) began, strains federative relations and impacts health management in municipalities of all sizes. Funding is recognised to be one of the factors that directly influence the decisions of local SUS managers, due to the availability of both local funds and those transferred by the federal government [1][2][3] . The fiscal regime 4 introduced by Constitutional Amendment No.…”

Section: Introductionmentioning

confidence: 99%

Fund transfers for combating COVID-19 from the perspective of municipal managers in São Paulo state, Brazil

Duarte,

Viana,

Garcia

et al. 2023

Ciênc. saúde coletiva

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The study examined municipal managers’ perceptions of extraordinary funding and its use to address COVID-19. In this multiple-case, quantitative and qualitative study, using embedded mixed methods, semi-structured interviews were conducted in six case-municipalities in São Paulo state. Secondary data for 2020 to 2022, drawn from information systems, were analysed. The municipalities differed by population, health expenditures and access to federal funding, making it possible to observe different financial management strategies and resource allocation. In addition to the extraordinary funding, considerable budget transfers were found to have been made by Parliamentary Amendments during the study period. In a context where the national Unified Health System is underfunded, extraordinary funding and budget transfers by Parliamentary Amendments often enabled managers to organise municipal health systems to meet their understanding of health needs and possible responses to those needs. Funding to address COVID-19 was allocated mainly to medium- and high-complexity services and to engaging private companies.

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Financiamento da saúde e dependência fiscal dos municípios brasileiros entre 2004 e 2019

Cited by 10 publications

References 12 publications

Economic Fluctuation and Public Health Financing in Brazil

Economic Fluctuation and Public Health Financing in Brazil

The financing of health in Vitória (ES): a look at primary care

Fund transfers for combating COVID-19 from the perspective of municipal managers in São Paulo state, Brazil

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