Federalismo, Relações Físicas e Financiamento do Sistema único de Saúde: a distribuição de receitas vinculadas à saúde nos orçamentos municipais e estaduais / Federalism, Physical Relations and Financing of the only System of Health: the distribution of entailed prescriptions to the health in the municipal and state budgets

RESUMO

O trabalho aborda as relações entre o federalismo fiscal e o financiamento do Sistema único de Saúde (SUS) no período de 1990 a 2002. Parte-se do pressuposto que decisões críticas dos atores federativos subnacionais estão submetidas aos critérios e condicionantes que regem a distribuição, apropiação e uso de recursos setoriais e de receitas próprias vinculadas à saúde pelos dispositivos da Emenda Constitucional n.29 de 2000. Na pesquisa, os resultados das regras que definem o financiamento descentralizado do SUS são analisados, comparando-se e correlacionando-se os valores das receitas públicas informadas pelos municípios e estados através do Sistema de Informações de Orçamentos Públicos em Saúde no ano 2002. Verifica-se que os municípios do Norte, Nordeste e aqueles com população de 20 mil a 100 mil habitantes, se comparados a outros grupos 1) possuem menores chances de ampliação de recursos próprios para a saúde como efeito da vinculação estabelecida pela Emenda Constitucional, já que a disponibilidade dessas fontes é relativamente mais baixa...

ABSTRACT

The thesis deals with the relationship between fiscal federalism and the financing of the Unified Health System (SUS), from 1990 until 2002. It is built on the assumption that critical decisions of subnational actors in the federation are bounded by criteria and conditions that rule the distribution, the appropriation and the use of sector resources and of their own fiscal resources that are bound to the health policy by the Constitutional Amendment nr. 29/2000. The outcomes of the rules that define the decentralized financing of SUS are analyzed in the thesis by comparing and correlating the amounts of the public revenues informed bymunicipalities and states through the Information System on Public Budgets for Health in the year 2002. By comparing municipalities of the Northern and Northeastern Regions and those withpopulation varying from 20,000 to 100,000 people with other groups it is verified that (1) they have fewer chances to invest more of their own resources in health as an effect of theconstitutional binding, given that the availability of these sources is relatively low; (2) they must develop a strong fiscal effort and compromise a larger part of their budgets in order toguarantee the matching of their resources to their health spending needs; and (3) they are the municipalities that the depend the most from health federal transfers in order to expand the resources destined to SUS and, because of that, they are subject to Ministry of Health’s induction and control mechanisms. As far as the states are concerned, there are important regional differences. The financial situation of the Northeastern states is particularly critical. Although the degree of binding of resources to the health sector in Brazil is comparable to other countries, it is possible to notice the heterogeneous conditions of financing, the fragmentation of the transfer mechanisms and the strong determination in the use of resources.