Analysis from the study “The Brazilian Health System at a Crossroads: Progress, Crisis and Resilience’, published in the BMJ Global Health journal found that between 2003 to 2014, municipal per capita spending on health grew by 126%,rising from R $ 315.7 to R $ 716.5 (inflation adjusted). Since 2015, however, expenses fell by 6.3% to R $ 671.1 in 2016.
By contrast, between 2003 and 2016, the federal government’s share of health financing fell from 50.0% to 40.8% of total public health expenditure.
As a result of progressive financial deterioration of states and municipalities, key areas are compromised even in their most primary actions, according to experts.
“The expected consequence is increased mortality from preventable causes and chronic diseases across all age groups, being more pronounced in vulnerable and poor regions with populations at risk”, says Adriano Massuda, a health practitioner, Harvard researcher at TH Chan School of Public Health and a consultant to Opas, who participated in the preparation of the document.
‘If we analyse the total public spending on health over the years, there has been a reduction in the proportion of federal transfers since SUS implantation.” In fiscal year 1988, nearly 75% of the federal resources were federal, and about 5%, municipal. In 2000, the federal transfer was approximately 50%, with municipalities accounting for 23% to 24%, and states with the remainder. In 2016, the federal counterpart was a little more than 40%”, he further states.
Though total health spending rose from 7.0% to 8.3% of Gross Domestic Product (GDP) between 2000 and 2014, with population coverage through the Family Health Strategy (ESF) rising from 7.6% to 58.2%, Massuda counters by pointing out the structural weaknesses of SUS, especially in relation to distribution of funds, remaining unresolved. These, according to analysis, include gaps in organisation and governance, low public funding and suboptimal resource allocation, leading to regional disparities in access to healthcare services as well as outcomes, with poorer regions most disadvantaged.
Massuda believes it is necessary to strengthen investment and improve the allocation of strategic resources, so that this impact can be absorbed in future.
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