The Political Economy of Health Services Provision in Brazil

Abstract

We examine the impact of local politics and voter preferences on the allocation of publicly subsidized the Unified and Decentralized Health Care System (SUS) health services across 4,338 counties in Brazil. SUS clinics, doctors, and nurses (per capita) are higher in counties with a higher share of uninsured in the population and with higher per capita incomes, as is consistent with a probabilistic voting model. Political participation (i.e., the fraction of the poor who vote) and the political power of the mayor (his vote share in the last election) are associated with more visible health inputs, namely, clinics and consultation rooms, but not with more doctors and nurses.

Voting Technology, Political Responsiveness, and Infant Health: Evidence From Brazil

“…The political consequences of this arrangement were aptly discussed in Mobarak, Rajkumar, and Cropper (2011), which noticed that the wealthier insured population "generally make little use of the SUS system" and that "the uninsured value SUS health services relatively more than the insured do." These differences are also prevalent in nationally representative opinion surveys: 49% of Brazilians list "improving health care services" as a government priority (more than any other area).…”

“…30 When these differing preferences are present, theories of redistributive politics predict that increased political participation (or enfranchisement) of the less educated should raise government spending on health care, as discussed in the Introduction. For instance, Mobarak, Rajkumar, and Cropper's (2011) analysis of health care provision in Brazilian municipalities is informed by a probabilistic voting model which "predicts that an increase in the voting rate of the poor will increase public health care provision." The results in this section test this prediction, with respect to the de facto enfranchisement promoted by EV.…”

Eqüidade e provisão de serviços públicos odontológicos no estado do Paraná

“…b O delineamento do presente estudo não permitiu abordar diretamente o acesso aos serviços, porém analisouse a possibilidade de acesso a partir da oferta. Segundo Mobarak et al, 14 a possibilidade de acesso dos indiví-duos com piores condições socioeconômicas tem sido associada à maior oferta de serviços de saúde. No presente estudo, observou-se a tendência de os municípios mais carentes apresentarem maior número de dentistas e equipamentos odontológicos por habitante.…”

Political and Institutional Drivers of Social Security Universalization in Brazil

“…About one-third of the population does not receive even one consultation per year and SUS covers a smaller share of health costs in the lower decile than in the middle and upper deciles of the income distribution (Ter-minassian 2013). Richer households resort to SUS services for the more costly specialized treatments, while using supplementary private health insurance for basic consultation and exams (Medici 2003;Mobarak et al 2011). A non-anticipated outcome of the constitutional right of the right to health is that citizens increasingly have resorted to the judicial system to ensure costly treatment that is rationed because of the universal and free-of-charge nature of the system (Menicucci and Machado 2010 was spent by this state of 11 million people on court-attained drugs for about 19,000 patients".…”

“…They are also higher in municipalities with higher per capita incomes since this increases the public budget constraint. Mobarak et al (2011) found that the importance of political factors depends on the health inputs examined. The percentage of the population that votes and the mayor's vote share in the 1996 elections correlated positively with the number of clinics and the number of consultations in the municipalities, a finding also present in terms of per capita health budget.…”