Intermunicipal health care consortia in Brazil: strategic behavior, incentives and sustainability

Abstract

This article studies strategic behavior in municipal health care consortia where neighboring municipalities form a partnership to supply high-complexity health care. Each municipality partially funds the organization. Depending on the partnership contract, a free rider problem may jeopardize the organization. A municipality will default its payments if it can still benefit from the services, especially when political pressures for competing expenditure arise. The main result is that the partnership sustainability depends on punishment mechanisms to a defaulting member, the gains from joint provision of services and the overall economic environment. Possible solutions to the incentive problem are discussed.

Secession of municipalities and economies of scale: Evidence from Brazil

“…In Brazil, there exists some form of intermunicipal cooperation data before the 1988 constitution, but much more was collected after that time (Linhares, ; Teixeira, Bugarin, & Dourado, ). These intermunicipal arrangements, known as intermunicipal consortiums, are nowadays regulated by a federal law (11,107/2005), and generally constitute horizontal, voluntary contracts, with the aim of supplying some type of public service or good (Linhares, ; Spink, ).…”

“…According to the Municipality Information Research (MUNIC, 1999), about 41 percent of Brazilian municipalities were part of some intermunicipal consortium in the following areas: health (37.3 percent), education (4.1 percent), housing (0.85 percent), machinery and equipment (4.3 percent), water supply (2.8 percent), sewer (1.5 percent), and garbage collection (3.28 percent). The available evidence and analyzes reveal some consensus about the motivation behind the Brazilian intermunicipal cooperation: given the large numbers of poor and small municipalities, on one hand, and the new municipal competencies specified by the 1988 constitution, on the other, intermunicipal cooperation is a way to guarantee the provision of public services and goods at affordable costs (Linhares, ; Spink, ; Teixeira et al., )…”

“…More specifically, Teixeira et al. () argued that the ability to provide specialized health services (the sector presenting the highest share of total intermunicipal cooperation agreements in Brazil) commonly requires scales of production that are incompatible with the small local populations in most Brazilian municipalities. Thus, we believe that an important motivation behind the Brazilian intermunicipal cooperation agreements is the requirement for economic efficiency through economies of scale.…”

O uso de contratos de gestão e incentivos profissionais no setor público de saúde

“…Para Os contratos de gestão nos serviços públicos de saúde O tema dos contratos de gestão em saúde é parte de uma importante agenda de discussão nos cenários brasileiro e internacional na organização de serviços de saúde 7,8,9,10,11 . A contratualização de resultados é apontada como uma das principais estratégias da Nova Gestão Pública, ou seja, dentre as que mais promoveram mudanças substantivas na qualidade dos serviços públicos 12 .…”

O efeito da intenção de reeleição sobre gastos em saúde: uma análise com base no modelo de reputação política

“…Dessa forma, se um município não tem recursos necessários para tratar certa enfermidade, o paciente pode ser transferido para outra localidade. Os custos do tratamento, entretanto, podem não ser completamente pagos pelo município de origem, o que pode levar a distorções nas despesas municipais (ver Teixeira et al, 2006) 6 . A variável dependente, LNSAUDE, é o logaritmo do gasto municipal em saú-de per capita, excluída as receitas advindas do Sistema Único de Saúde (SUS).…”