Financing public health care in Brazil: Impact of constitutional budget ... Health Care Unified System) in the three government levels (union, states, counties).
International Health Economics Association 5th World Congress: Investing in Health Monday, July 11 0800~1700 - Room Atrium: Poster-2 Financing public health care in Brazil: Impact of constitutional budget resource earmarking Authors: Ricardo Abreu, Rodrigo Benevides Presenter: Ricardo Abreu , Brazil Introduction: This article analyzes the financing of SUS (Sistema Único de Saúde Health Care Unified System) in the three government levels (union, states, counties) based on taxes revenue data and expenditure with public health care services. Constitutional Amendment 29/2000 (CA 29) fixes an annual growing percentage of health care expenditure on the total government budget for each level, in order to lessen the unmet population needs. In addition, possible financing scenarios for health care are analyzed from the implementation of CA 29 on and through available revenue for SUS until the year 2007. Objective: Evaluate the financing structure of public health care in Brazil, the financial impact of constitutional resource earmarking and estimate the revenue available for SUS until the year of 2007. Methodology: The health income and expenditure revenue data of the three government levels are presented for the period of 1995 - 2003 and estimated until 2007, based on projections considering possible scenarios for the regulation of CA 29. The values for the period of 1995 - 2007 were converted to prices in the year of 2003 and to the average prices variation index measured by Consumer Price Index. For the period of 2003-2007, the taxes revenue grows according to the nominal variation of GNP, maintaining the proportion revenue/GNP. Results: In case the current rule of earmarking is applied to the union, health expenditure should approximate 4% of the GNP, an increase of about one third in relation to the situation prior to the implementation of resource earmarking. This increase is due to the growing percentages of revenue in states and counties, once the investment of the union, by definition, keeps its participation in the Gross National Product. CA 29 has caused important effects, elevating the expenditure in real terms in 40,4% and 38,0%, respectively, for states and counties, in 2 years. Conclusion: The study of health care finance is a very important tool for the management of health policies for demonstrating the dynamics. of budget restriction when federal and local managers design and implement such policies. Alternative revenue scenarios for the Union would elevate the revenue available for SUS, however they face budget pressure form other government activities, given the high participation of health expenditures in the Union budget. CA 29 has caused the growth, in real terms, of health budget of the states and counties by 40,4% and 38,0%, respectively, in 2 years. CA 29 is an important tool to guarantee the minimum resources for financing public health care in Brazil and so for increasing predictability about resources, improving the efficiency of planning.
