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  1. Gastos em saúde e educação no Brasil: impactos da unificação dos pisos constitucionais
    Autor*in: Vieira, Fabiola Sulpino; Servo, Luciana Mendes Santos; Benevides, Rodrigo Pucci de Sá e; Piola, Sérgio F.; Orair, Rodrigo Octávio
    Erschienen: setembro de 2020
    Verlag:  Instituto de Pesquisa Econômica Aplicada, Rio de Janeiro

    This text aims at investigating the effects of unifying the constitutional minimum levels for healthcare and education expenditures, especially in municipalities. It provides a contribution to the public debate on a series of legislative initiatives,... mehr

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    This text aims at investigating the effects of unifying the constitutional minimum levels for healthcare and education expenditures, especially in municipalities. It provides a contribution to the public debate on a series of legislative initiatives, such as the Constitutional Amendment Proposals 186/2019 and 188/2019. The analysis is based on primary data from budget reports of the Brazilian Union, the States and the Federal District, and the Municipalities. Results show that expenditures in both areas exceeded the sum of the minimums in each level of government. This surplus is higher for education, in the case of the Union, the States and the Federal District. Whereas in the case of Municipalities the surplus if higher for healthcare. The detailed analysis of expenditures (as percentage of total revenues) points that 80% of the 5,480 municipalities with available data were above 15.75% for healthcare and 26.25% for education, which exceeds the respective minimums of 15% and 25%. With regard to the risk of decreasing expenditures in a scenario of minimums unification, it is identified that 951 municipalities face a higher risk in the area of education, given the fact that their education expenditures are close to the border of the minimum and healthcare expenditures are above the minimum boundary. While 97 municipalities face higher risk in the area of healthcare, as the healthcare expenditure is close to the minimum border and education expenditure is far from it. These findings support the hypothesis that, in a context of competition between financial sources, healthcare expenditures tend to be more resilient, since they are less elastic, and, therefore, education expenditures are at greater risk of suffering losses.

     
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    hdl: 10419/240790
    Schriftenreihe: Texto para discussão / Ipea ; 2596
    Umfang: 1 Online-Ressource (circa 68 Seiten), Illustrationen
  2. As emendas parlamentares e a alocação de recursos federais no sistema único de saúde
    Autor*in: Piola, Sérgio F.; Vieira, Fabiola Sulpino
    Erschienen: julho de 2019
    Verlag:  Instituto de Pesquisa Econômica Aplicada, Rio de Janeiro

    The purpose of this text is to analyze the weight and the allocation of resources through parliamentary amendments in the federal budget to finance expenditures with public health services (ações e serviços públicos de saúde - ASPS) from 2015 to... mehr

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    The purpose of this text is to analyze the weight and the allocation of resources through parliamentary amendments in the federal budget to finance expenditures with public health services (ações e serviços públicos de saúde - ASPS) from 2015 to 2018. An exploratory and descriptive study of the Ministry of Health budget execution was conducted, focusing on the resources that were allocated to health programs to assist specific beneficiaries. Data were obtained from the SIGA Brasil, a public access system maintained by the Federal Senate. Some indicators were calculated to support the analysis. The results show that the Ministry of Health is engaged in a larger volume of expenditure than is determined by mandatory parliamentary amendments, and that its expenses associated with other, non-mandatory parliamentary amendments, are occurring in very high level. In 2018, the mandatory parliamentary amendments execution was R$ 4.4 billion and the expenses associated with parliamentary amendments in general totaled R$ 8.8 billion. It was identified an increase in the allocation of resources for the costing of the Unified Health System (Sistema Único de Saúde - SUS) and deficit of transparency in the budget-financial execution of the resources allocated to the increment of the resources for primary care (Piso da Atenção Básica - PAB) and the resources for medium and high complexity services (Teto de Média e Alta Complexidade - Teto MAC). There was an increase in the allocation of funds to increase the PAB and Teto MAC in the analyzed period, so that these transfers increased from R$ 240.1 million in 2014 to R$ 6.6 billion in 2018, at constant values, with an increase of 2,650% in this period. As in 2018, expenses with ASPS associated with parliamentary amendments totaled R$ 8.8 billion, the resources allocated by parliamentarians for temporary increase of the PAB and Teto MAC that year correspond to 74.9% of total expenses associated with amendments parliamentarians. Inequalities were also identified in the allocation of resources for the costing of the services of both the Teto MAC and the PAB. In the latter case, without observing the criteria established for resource allocation. Finally, it is concluded that the allocation of resources for SUS funding through parliamentary amendments may be generating more inequalities in the provision of health services in the system, something that needs to be investigated in detail in future studies.

     
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    hdl: 10419/211448
    Schriftenreihe: Texto para discussão / Ipea ; 2497
    Umfang: 1 Online-Ressource (circa 56 Seiten), Illustrationen
  3. Vinculação orçamentária do gasto em saúde no Brasil
    resultados e argumentos a seu favor
    Autor*in: Vieira, Fabiola Sulpino; Piola, Sérgio F.; Benevides, Rodrigo Pucci de Sá e
    Erschienen: outubro de 2019
    Verlag:  Instituto de Pesquisa Econômica Aplicada, Brasília

    Allocating sufficient resources to the Unified Health System (SUS) is a basic premise for compliance by the State with its duty to guarantee universal, equal and integral access to health goods and services in Brazil. As a way of ensuring minimal... mehr

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    Allocating sufficient resources to the Unified Health System (SUS) is a basic premise for compliance by the State with its duty to guarantee universal, equal and integral access to health goods and services in Brazil. As a way of ensuring minimal resources to the system, the compulsory expenditure with health was instituted. Recently, amid the fiscal crisis and the changes in the political environment in the country, the extinction of this compulsory expenditure is considered. In this context, the objective of this paper is to present evidence and discuss the relevance of maintaining the compulsory public health expenditure, thus contributing to the public debate on the topic. A narrative review of the technical-scientific literature and legal documents was performed to organize the discussion on the subjects treated in two perspectives: i) a historical perspective on the regulation of the minimum application of resources in the SUS, including in the report the propositions that weren't approved and the motivations for this regulation; and ii) a theoretical-empirical perspective on the hypothesis that universal public health systems, such as the SUS, and the compulsory health expenditure in Brazil are relevant to the right to health as determined by the Federal Constitution of 1988 (CF/1988). Considering the evidence presented about the lack of priority with the system and, consequently, with the guarantee of the right to health in Brazil, the conclusion is that the compulsory health expenditure remains essential. Even so, this obligation alone does not solve the financing problem of the system, since in spite of the institution of the floors of application from 2000, health expenses are still very low compared to those countries with similar income and who do not have a universal health system. However, it is an important mechanism to protect against throwback in the supply of health goods and services, something that is forbidden by CF/1988. The stability in the financing of the SUS is fundamental and the compulsory health expenditure fulfilled vital role, considering the trajectory of public health financing. Nonetheless, the country needs to make an additional effort to guarantee sufficient resources to finance the SUS, given the challenges posed to the system stemming from epidemiological, demographic and technological issues that drive the growth of health spending.

     
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    hdl: 10419/211465
    Schriftenreihe: Texto para discussão / Ipea ; 2516
    Umfang: 1 Online-Ressource (circa 70 Seiten), Illustrationen
  4. Coordenação entre instâncias de governo e o papel do Ministério da Saúde no Sistema Único de Saúde
    Autor*in: Piola, Sérgio F.
    Erschienen: março de 2022
    Verlag:  Instituto de Pesquisa Econômica Aplicada, Brasília

    Brazil is a federation composed by the Federal Government, twenty-six states and the Federal District and 5,570 municipalities. The organization of the national health system is a shared responsibility of this three spheres of government and must... mehr

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    Brazil is a federation composed by the Federal Government, twenty-six states and the Federal District and 5,570 municipalities. The organization of the national health system is a shared responsibility of this three spheres of government and must comply to the constitutional principles of universal coverage, comprehensiveness and equity, and also with the decentralized management of the the Unified Health System (SUS). This constitutes an immense challenge. To preserve the constitutional principles of the system, several instruments were used to reinforce coordination between the levels of government, among which the transfers of federal resources to states, the Federal District and municipalities. Collegiate management bodies were also organized. Various initiatives and experiences were implemented to improve and conduct a systemic coordination in of the different dimensions of the health system. In this context, this work, based on a narrative review of technical-scientific literature and legal documents, analyzes the experience of the SUS from the following perspectives: i) constitutional and legal foundations that organize the health system; ii) SUS implementation experience, seeking to identify the main advances, problems and challenges; iii) identification of the relevance of federative coordination for the SUS, highlighting, in this sense, the importance of the role of the Federal Government in providing effective support for the achievement of the constitutionally defined principles for the health area, especially in countries with the characteristics of Brazil.

     
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    hdl: 10419/265264
    Schriftenreihe: Texto para discussão / Ipea ; 2745
    Schlagworte: public health; unified health system; intergovernmental relations; federalism; decentralization; federative coordination
    Umfang: 1 Online-Ressource (circa 50 Seiten), Illustrationen
  5. Prioriza SUS
    análise de problemas, recomendação de estratégias e a visão do consórcio intergovernamental público como instrumento de reforço à Coordenação Federativa do Sistema Único de Saúde
    Autor*in: Piola, Sérgio F.; Vieira, Fabiola Sulpino; Servo, Luciana Mendes Santos; Sá, Edvaldo Batista de; Benevides, Rodrigo Pucci de Sá e
    Erschienen: julho de 2023
    Verlag:  Instituto de Pesquisa Econômica Aplicada, Brasília

    This text analyzes issues related to the federative coordination of the Unified Health System (SUS), with negative repercussions on access to public health goods and services, aiming at the identification and recommendation of measures that... mehr

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    This text analyzes issues related to the federative coordination of the Unified Health System (SUS), with negative repercussions on access to public health goods and services, aiming at the identification and recommendation of measures that contribute to the gradual solution of access difficulties. Following the methodology of analysis of public policies, after the definition of the public problem as "difficulty of timely, effective and equitable access to public health goods and services" a tree of the problem was elaborated and several causes and consequences were identified. The cause chosen for intervention in this study is "insufficient federative coordination", which is also considered a structural problem of the SUS. One of the ways to reduce the problem of timely and equitable access to health care is to increase the availability of health goods and services in the most deprived areas. But this should be done in the most effective way, within the principles and guidelines of the SUS, based on a cooperative action among the federated entities. Thus, although there are other ways of expanding the public supply of health goods and services, it is understood that, in specific situations, the intergovernmental consortium is an option that cannot be ruled out. The preliminary proposal of this text was analyzed in a public policy forum with the participation of researchers, technicians and managers of the SUS, with recognized knowledge on the subject. The contributions of the forum participants were included in the text and summary of the discussions are inserted in appendix.

     
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    hdl: 10419/285022
    Schriftenreihe: Texto para discussão / Ipea ; 2900
    Schlagworte: health policy; federative coordination in health; Unified Health System; public consortia
    Umfang: 1 Online-Ressource (circa 52 Seiten), Illustrationen
  6. Financiamento do Sistema Único de Saúde
    análise do impacto financeiro de propostas legislativas para aumentar os recursos federais alocados ao sistema
    Autor*in: Piola, Sérgio F.
    Erschienen: outubro de 2023
    Verlag:  Instituto de Pesquisa Econômica Aplicada, Rio de Janeiro

    Ensuring sufficient resources for the Unified Health System (SUS) has been a concern since its inception. The linking of resources from the Social Security Budget (OSS) provided for in the Transitional Provisions Act (ADCT) of the Federal... mehr

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    Ensuring sufficient resources for the Unified Health System (SUS) has been a concern since its inception. The linking of resources from the Social Security Budget (OSS) provided for in the Transitional Provisions Act (ADCT) of the Federal Constitution of 1988 was not complied with, nor were the first Budget Guidelines Law (LDO) able to maintain a regular contribution of resources that the new system required. The approval of Constitutional Amendment (CA) 29 of 2000 brought the states, the Federal District and municipalities to the more regular financing of the SUS, but did not guarantee the necessary increase in federal resources, although it contributed to its stability, even if at an insufficient level. The failure of this attempt to increase the federal contribution to the SUS led to the intensification of the legislative production of proposals, of a very varied nature, to help solve the insufficiency of the federal contribution to the system. In this text, we seek to rescue the path of the main groups propositions that were processed by the Federal Chamber from 2003 to 2020 and made estimates of the financial impact of typical proposals of each group if they had been approved, comparing the estimated results of these proposals with the federal expenditure executed in the period with public health actions and services (ASPS). The study shows that there was no shortage of proposals from the Legislative in order to increase federal participation in the financing of SUS. It is observed that a greater stability in financing, provided by CA 29 of 2000, was fundamental for public health services not to suffer a solution of continuity, but that an additional political effort is needed to support the SUS so that this system increases its effective coverage, reduces inequalities of access and can effectively face future difficulties arising from epidemiological, demographic and technological factors that will put even more pressure on health spending and so that Brazil can get out of the uncomfortable position of being one of the few countries that, even having a system with the obligation to provide universal and comprehensive care, has a public spending on health much lower than private spending.

     
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    hdl: 10419/285059
    Schriftenreihe: Texto para discussão / Ipea ; 2937
    Schlagworte: healthcare financing; public funding of health care; Unified Health System
    Umfang: 1 Online-Ressource (circa 50 Seiten), Illustrationen
  7. Prioriza SUS
    proposta para o aperfeiçoamento da gestão do SUS por meio do planejamento, do monitoramento e da avaliação da ação governamental
    Autor*in: Vieira, Fabiola Sulpino; Servo, Luciana Mendes Santos; Piola, Sérgio F.; Sá, Edvaldo Batista de; Benevides, Rodrigo Pucci de Sá e
    Erschienen: maio de 2023
    Verlag:  Instituto de Pesquisa Econômica Aplicada, Rio de Janeiro

    The objective is to analyze problems of the health sector in Brazil, with emphasis on the management of the SUS, aiming at the elaboration of concrete interventions proposals to ensure the population's access to universal, egalitarian and... mehr

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    The objective is to analyze problems of the health sector in Brazil, with emphasis on the management of the SUS, aiming at the elaboration of concrete interventions proposals to ensure the population's access to universal, egalitarian and comprehensive healthcare. The methodological framework of public policy analysis was used to examine healthcare problems and propose solutions. The public problem, which is the distance between current and desired situation from the point of view of a relevant actor was defined as "difficulty in timely, effective and equitable access to health care". A problem tree was created, and several causes were identified. This study concentrates in a structural problem of the SUS that was called 'deficient strategic management', which has among its causes "deficient and insufficient planning, monitoring and evaluation processes". Some actions were proposed to face this problem. Next, a public policy forum was held with the participation of SUS researchers, workers, and managers with relevant knowledge on the subject, to discuss the preliminary actions proposal. Contributions from forum participants were incorporated, improving the actions initially proposed and adding a new action to the list of measures suggested as a response to the structural problem under analysis. Finally, it is recommended to evaluate the appropriateness of the solutions suggested in the discussions that may take place under the initiative of the Ministry of Health, with the objective of agreeing on actions that promote planning, monitoring and evaluation in the SUS and, with that, the improvement of its strategic management.

     
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    hdl: 10419/285002
    Schriftenreihe: Texto para discussão / Ipea ; 2879
    Schlagworte: Health policy; health management; health policy; planning and management; health planning; health evaluation; Unified Health System
    Umfang: 1 Online-Ressource (circa 81 Seiten), Illustrationen
  8. Financiamento das políticas sociais nos anos 1990
    o caso do Ministério da Saúde
    Autor*in: Ocké-Reis, Carlos Octávio; Ribeiro, José Aparecido Carlos; Piola, Sérgio F.
    Erschienen: junho de 2001
    Verlag:  Instituto de Pesquisa Econômica Aplicada, Brasília

    The stabilization of public health financing has been one of the main concerns of various areas of society and of the state. This article contributes to this discussion from a specific context: to evaluate the behavior of the resource funds and... mehr

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    The stabilization of public health financing has been one of the main concerns of various areas of society and of the state. This article contributes to this discussion from a specific context: to evaluate the behavior of the resource funds and expenses of the Ministry of Health. The composition of finance by sources; the evolution of expenses by economic category and sub programs; and the evolution of CPMF will all be analyzed. We also discuss the impact of this new "tribute" (CPMF) about the financing of the Ministry of Health. Finally, we present a prospective vision of the 29th Amendment which defines new rules to the financing of health policies in the country.

     
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    Schriftenreihe: Texto para discussão / Ipea ; no 802
    Umfang: 1 Online-Ressource (circa 29 Seiten), Illustrationen
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  9. Consolidação do gasto com ações e serviços públicos de saúde
    trajetória e percalços no período de 2003 a 2017
    Autor*in: Piola, Sérgio F.; Benevides, Rodrigo Pucci de Sá e; Vieira, Fabiola Sulpino
    Erschienen: dezembro de 2018
    Verlag:  Instituto de Pesquisa Econômica Aplicada, Rio de Janeiro

    This text presents a consolidation of Brazilian public health spending (ASPS) of the three spheres of government in the period 2003 to 2017. The main objective, besides analyzing the evolution of expenditure since the approval of the Constitutional... mehr

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    This text presents a consolidation of Brazilian public health spending (ASPS) of the three spheres of government in the period 2003 to 2017. The main objective, besides analyzing the evolution of expenditure since the approval of the Constitutional Amendment 29 in 2000 (CA 29), is to demonstrate the expenditure distribution by geographic regions. We used public health spending data from Information System on Public Budgets in Health, and data available by the Ministry of Health (MoH) about federal health spending by states for the regionalization of the federal resources to ASPS. We have found that there was increasing of the binding resources to health by the three spheres. However, this increase was insufficient to reduce regional inequalities more significantly, since the necessary changes in the allocation criteria of the resources transferred by the MoH were not implemented, in order to meet the objectives defined by EC 29 and the law 141/2012 with regard to the allocation of the resources by the Union. Finally, we observed a fall in the applications in the years 2015 and 2016, a situation that was only temporarily temporized in 2017, because the final percentage of 15% of Net Current Revenue as the federal minimum spending on health was anticipated with the approval of the Constitutional Amendment 95 in 2016.

     
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    hdl: 10419/211390
    Schriftenreihe: Texto para discussão / Ipea ; 2439
    Umfang: 1 Online-Ressource (circa 36 Seiten), Illustrationen
  10. Restos a pagar de despesas com ações e serviços públicos de saúde da união
    impactos para o financiamento federal do sistema único de saúde e para a elaboração das contas de saúde
    Autor*in: Vieira, Fabiola Sulpino; Piola, Sérgio F.
    Erschienen: agosto de 2016
    Verlag:  Instituto de Pesquisa Econômica Aplicada, Brasília - DF

    The objective of this study is to analyze the impact of unpaid commitments by the central government on public healthcare financing and national health expenditure estimates. The health spending data were obtained from the federal public budget... mehr

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    The objective of this study is to analyze the impact of unpaid commitments by the central government on public healthcare financing and national health expenditure estimates. The health spending data were obtained from the federal public budget system, Siga Brasil, and were analyzed for their registration as unpaid commitments and canceled unpaid commitments from 2002 to 2014. We found that healthcare spending by the federal government was lower than the minimum level required by law for most years. As a result, approximately R$ 11.3 billion were not allocated to public healthcare by the federal government. As for health expenditure estimates, we found that the cancellation of unpaid commitments, among other issues related to national public accounting, affects the estimation of health spending by the accrual method, which is the recommended regimen in health accounts.

     
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    hdl: 10419/146661
    Schriftenreihe: Texto para discussão / Ipea ; 2225
    Umfang: 1 Online-Ressource (circa 76 Seiten), Illustrationen
  11. Implicações do contingenciamento de despesas do Ministério da Saúde para o financiamento federal do sistema Único de Saúde
    Autor*in: Vieira, Fabiola Sulpino; Piola, Sérgio F.
    Erschienen: dezembro de 2016
    Verlag:  Instituto de Pesquisa Econômica Aplicada, Brasília - DF

    The Unified Health System (SUS) financing is a recurrent theme in the sectoral debate. After 28 years since the Federal Constitution promulgation, its failure remains identified as a major structural problem for the public healthcare system... mehr

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    The Unified Health System (SUS) financing is a recurrent theme in the sectoral debate. After 28 years since the Federal Constitution promulgation, its failure remains identified as a major structural problem for the public healthcare system consolidation. In the federal government, the spending constraint, the high amount of unpaid commitments and the systematic process of transforming the minimum level resources allocation on actions and public health services (ASPS) into maximum level were factors that contributed to the restriction of the public health financing. In this paper, we analyze the possible implications of government spending constraints, through budget and financial programming, to the SUS federal financing. The following issues relating to expenses on ASPS are discussed: i) limitation of the commitments; ii) limiting of the expenses payment; iii) expenses registration as unpaid commitments; iv) unpaid commitments cancellation; and v) the effect of unpaid commitments on the minimum level of spending on ASPS. Finally, some considerations about the spending constraint to the SUS federal financing are discussed.

     
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    hdl: 10419/177476
    Schriftenreihe: Texto para discussão / Ipea ; 2260
    Umfang: 1 Online-Ressource (circa 60 Seiten), Illustrationen
  12. Transferências de recursos federais do Sistema Único de Saúde para estados, distrito federal e municípios
    os desafios para a implementação dos critérios da Lei Complementar no 141/2012
    Autor*in: Piola, Sérgio F.
    Erschienen: abril de 2017
    Verlag:  Instituto de Pesquisa Econômica Aplicada, Brasília - DF

    This paper presents the challenges for the implementation of the intergovernmental transferring criteria established in Complementary Law 141, of January 2012, which regulates Constitutional Amendment No. 29, of 2000, for the Unified Health System... mehr

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    This paper presents the challenges for the implementation of the intergovernmental transferring criteria established in Complementary Law 141, of January 2012, which regulates Constitutional Amendment No. 29, of 2000, for the Unified Health System (SUS). The Law establishes norms for a resource allocation that aims the reduction of regional disparities, old demand of this sector’s researchers. This new model of financial resources allocation requires a shift in the logic that has driven the federal resources allocation on health sector in Brazil, furthermore it implies structural changes in the distribution patterns applied by the Ministry of Health.

     
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    Volltext (kostenfrei)
    Quelle: Verbundkataloge
    Sprache: Portugiesisch
    Medientyp: Buch (Monographie)
    Format: Online
    Weitere Identifier:
    hdl: 10419/177514
    Schriftenreihe: Texto para discussão / Ipea ; 2298
    Umfang: 1 Online-Ressource (circa 50 Seiten), Illustrationen