Crise e federalismo: tendências e padrões regionais das receitas e despesas em saúde dos estados brasileiros

Contarato, Priscilla Caran; Lima, Luciana Dias de; Leal, Rodrigo Mendes

doi:10.1590/1413-812320182412.25302019

Cited by 6 publications

(3 citation statements)

References 17 publications

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“…Nesse contexto, o equilíbrio das finanças estaduais se torna um grande desafio na medida em que a "guerra fiscal" e o endividamento se intensificam em meio a um processo de recentralização e redução de repasses federais concomitante ao aumento de pressão política por repasse aos municípios numa situação de escassez de recursos 9 .…”

Section: Grupounclassified

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

Cruz

Barros²,

Souza³

2022

Ciênc. saúde coletiva

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Resumo Este artigo descreve a evolução do financiamento municipal do Sistema Único de Saúde, de 2004 a 2019, considerando receitas e despesas de fontes próprias e não-próprias, analisa a redistribuição fiscal, de acordo com o porte populacional e a renda média domiciliar, e compara essa evolução em dois períodos, caracterizados como de crescimento econômico (2004-2014) e de recessão (2015-2019). O estudo se baseou em dados do Sistema de Informações sobre Orçamentos Públicos em Saúde. Constatou-se crescimento real dos gastos municipais em saúde de 2004 a 2014 (156,3%), com queda entre 2014 e 2015, seguida de recuperação até 2019. Na recessão, detectou-se aumento global da dependência fiscal dos municípios, indicada pelo aumento de receitas não-próprias, mesmo com a diminuição da participação da União nas transferências. O crescimento das despesas próprias em saúde foi menor entre os municípios de menor renda domiciliar, enquanto para as despesas não-próprias foi maior nos municípios de menor porte populacional. Em suma, indica-se um processo de incremento dos gastos municipais em saúde, assim como o aumento da dependência fiscal para custeio da saúde, intensificado após a crise de 2015, que atingiu especialmente os municípios de pequeno porte e de menor renda domiciliar.

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Section: Grupounclassified

“…Assim, mesmo com a EC nº 29/2000, críticos apontam necessidades de aperfeiçoamento do sistema de repartição e aplicação fiscal, uma vez que o subfinanciamento crônico do SUS não foi superado. Além disso, é preciso propor dispositivos que reduzam as desigualdades inter-regionais e permitam uma maior colaboração intergovernamental 1,2,9 .…”

Section: Introductionunclassified

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

Cruz

Barros²,

Souza³

2022

Ciênc. saúde coletiva

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“…In fact, the Brazilian public health system has long been characterized by insufficient funding and irregular flow of resources (Servo et al, 2011). In Brazil, the public health system is jointly financed by the three spheres of government, but service provision is highly decentralized, being mainly offered at the municipality level (Contarato, Lima and Leal, 2019). Nevertheless, it worth noting that the existing (vertical) fiscal imbalance gives a key role to top-down transfers in the financing of public health services (Barros and Piola, 2016).…”

Section: Research Problemmentioning

confidence: 99%

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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The role of public social expenditure for mitigating local income inequality: An investigation across spatial scales in Austria

Neuhuber,

Schneider

2024

Journal of Regional Science

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This paper investigates the role of municipal and provincial public social spending for local income inequality after taxes and transfers in Austria. We utilize a spatial multi‐level model, which allows us to analyze the contribution of three spatial scales (municipal, district, and provincial level) to municipal income inequality. Our analysis shows that the effect of public social spending on local Gini indices does not only differ across provinces but also across municipalities which indicates that the potential cushioning effect of social expenditure is highly localized. Further splitting total public social expenditure into three distinct categories (education, health, social protection) reveals that spending on social protection has the highest effect on local inequality across all provinces, while health spending does not exert a discernible influence in any province. The method and results presented in this paper are of international interest for policymakers and researchers who aim to investigate whether the same patterns hold true in other countries.

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Crise e federalismo: tendências e padrões regionais das receitas e despesas em saúde dos estados brasileiros

Cited by 6 publications

References 17 publications

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

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

Economic Fluctuation and Public Health Financing in Brazil

The role of public social expenditure for mitigating local income inequality: An investigation across spatial scales in Austria

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