Family out-of-pocket expenditure for type 2 diabetes mellitus care and percentage of family income.

BACKGROUND: Type 2 diabetes has economic implications involving family income and out-of-pocket spending. OBJECTIVE: Determine family out-of-pocket expenditure for type 2 diabetes mellitus care and percentage of family income. MATERIAL AND METHODS: Study of family out-of-pocket spending in families with patients with type 2 diabetes treated at primary care level. Out-of-pocket expenses included expenses for transportation, food-drinks, and external medications. Family income corresponded to the total economic income contributed by family members. The percentage of out-of-pocket spending in relation to family income was identified with the relationship between these two variables. Statistical analysis included averages and percentages. RESULTS: The annual family out-of-pocket expenditure on transportation was $2,621.24, the family out-of-pocket expenditure on food and beverages was $1,075.67, and the family out-of-pocket expenditure on external medications was $722.08. The total annual family out-of-pocket expense was $4,418.89 and corresponds to 4.73% of family income. CONCLUSION: The family out-of-pocket expense in the family with a patient with diabetes mellitus 2 was $4,418.89 and represents 4.73% of the family income.

ANTECEDENTES: La diabetes tipo 2 tiene implicaciones económicas en el ingreso familiar y el gasto de bolsillo. OBJETIVO: Determinar el gasto de bolsillo familiar en la atención de la diabetes mellitus tipo 2 y el porcentaje que representa en el ingreso familiar. MATERIAL Y MÉTODOS: Estudio de gasto de bolsillo de las familias con pacientes con diabetes tipo 2 atendidos en el primer nivel de atención. El gasto de bolsillo familiar incluyó gasto en traslado, alimentos-bebidas y medicamentos externos. El ingreso familiar correspondió al total de ingresos económicos aportados por los miembros de la familia. El porcentaje del gasto de bolsillo con relación al ingreso familiar se identificó con la relación entre estas dos variables. El análisis estadístico incluyó promedios y porcentajes. RESULTADOS: El gasto de bolsillo familiar anual en transporte fue de $2621.24, en alimentos y bebidas fue de $1075.67 y en medicamentos externos fue de $722.08. El gasto familiar de bolsillo total anual fue de $4418.89 y correspondió a 4.73 % del ingreso familiar. CONCLUSIÓN: El gasto de bolsillo en las familias con un paciente con diabetes mellitus tipo 2 fue de $4418.89 y representó 4.73 % del ingreso familiar.

Spending on nucleos(t)ide analogues for hepatitis B in medicaid beneficiaries: 2012-2021.

INTRODUCTION AND OBJECTIVES: Treatment of chronic hepatitis B (CHB) with nucelos(t)ide analogues (NA) can improve outcomes, but NA treatment is expensive for insurance plans. MATERIALS AND METHODS: The Centers for Medicare & Medicaid Services database was assessed from 2012 to 2021 to assess the use of NA for CHB in patients on Medicaid. Data extracted included the number of claims, units, and costs of each agent stratified by originator and generic. RESULTS: Over the study period, 1.9 billion USD was spent on NA, with spending peaking in 2016 at $289 million US, which has subsequently decreased. Lower expenditures since 2016 have been associated with increased use of generics. The use of generic tenofovir or entecavir led to savings of $669 million US over the study period. CONCLUSIONS: Increased generic use has significantly reduced expenditures for NA drugs; policy shifts towards generic drug use may help with sustainability.

Future health expenditure in the BRICS countries: a forecasting analysis for 2035.

BACKGROUND: Accelerated globalization especially in the late 1980s has provided opportunities for economic progress in the world of emerging economies. The BRICS nations' economies are distinguishable from other emerging economies due to their rate of expansion and sheer size. As a result of their economic prosperity, health spending in the BRICS countries has been increasing. However, health security is still a distant dream in these countries due to low public health spending, lack of pre-paid health coverage, and heavy out-of-pocket spending. There is a need for changing the health expenditure composition to address the challenge of regressive health spending and ensure equitable access to comprehensive healthcare services. OBJECTIVE: Present study examined the health expenditure trend among the BRICS from 2000 to 2019 and made predictions with an emphasis on public, pre-paid, and out-of-pocket expenditures for 2035. METHODS: Health expenditure data for 2000-2019 were taken from the OECD iLibrary database. The exponential smoothing model in R software (ets ()) was used for forecasting. RESULTS: Except for India and Brazil, all of the BRICS countries show a long-term increase in per capita PPP health expenditure. Only India's health expenditure is expected to decrease as a share of GDP after the completion of the SDG years. China accounts for the steepest rise in per capita expenditure until 2035, while Russia is expected to achieve the highest absolute values. CONCLUSION: The BRICS countries have the potential to be important leaders in a variety of social policies such as health. Each BRICS country has set a national pledge to the right to health and is working on health system reforms to achieve universal health coverage (UHC). The estimations of future health expenditures by these emerging market powers should help policymakers decide how to allocate resources to achieve this goal.

Morbi-mortalidade e gastos hospitalares com idosos de Minas Gerais, Brasil / Morbis-mortality and hospital costs with elderly people from Minas Gerais, Brazil / Morbi-mortalidad y gasto hospitalario en ancianos de Minas Gerais, Brasil

Introdução: O envelhecimento populacional é uma realidade em todo o mundo, representando um desafio significativo para os sistemas de saúde. Objetivo: Descrever o perfil de morbidades e os gastos relacionados a internações de idosos em comparação aos adultos registradas no estado de Minas Gerais, Brasil, entre 2008 e 2017. Métodos: Estudo descritivo, de corte transversal, com dados do DATASUS e com base na CID-10. Resultados: Embora o maior número de internações esteja na faixa etária adulta, a proporção de gastos é maior com os idosos, com maior prevalência entre doenças mentais e comportamentais, osteomusculares e do tecido conjuntivo, seguidos das doenças de causas externas e do aparelho circulatório. Conclusão: Sugere-se a adoção de políticas mais abrangentes e maior investimento em ações de promoção da saúde, prevenção de agravos e tratamento oportuno e adequado para as doenças mais prevalentes nos idosos, em especial na atenção primária à saúde.

Introduction: Population aging is a reality around the world, representing a significant challenge for health systems. Objective: To describe the profile of morbidities and spending related to hospitalizations of elderly in comparison to adults registered in the state of Minas Gerais, Brazil, between 2008 and 2017. Methods: Descriptive, cross-sectional study with data from DATASUS and based on ICD-10. Results: Although the highest number of hospitalizations is in the adult age group, the proportion of expenditures is higher with the elderly, with a higher prevalence among mental and behavioral diseases, osteomuscular diseases and connective tissue, followed by diseases of external causes and the circulatory system. Conclusion: It is suggested to adopt more comprehensive policies and to invest more in actions to promote health, prevention of diseases and timely and adequate treatment for the most prevalent diseases in the elderly, especially in primary health care.

Introducción: El envejecimiento de la población es una realidad mundial, que representa un importante desafío para los sistemas de salud. Objetivo: Describir el perfil de morbilidad y los gastos relacionados con las internaciones de los ancianos en comparación con los adultos registrados en el estado de Minas Gerais (Brasil) entre 2008 y 2017. Métodos: estudio descriptivo, transversal con datos DATASUS y basado en CID-10. Resultados: Aunque el mayor número de internaciones se encuentra en el grupo de edad adulta, la proporción de gastos es mayor con los ancianos, con una mayor prevalencia entre las enfermedades mentales y conductuales, las enfermedades osteomusculares y el tejido conjuntivo, seguidas de enfermedades de causas externas y el aparato circulatorio. Conclusión: Se sugiere adoptar políticas más amplias e invertir más en acciones para promover la salud, prevenir las agravaciones y el tratamiento oportuno y adecuado de las enfermedades más prevalentes en las personas de edad, especialmente en la atención primaria de la salud.

Custo de um município do sul do Brasil com medicamentos de uso contínuo dispensados na Atenção Primária à Saúde / Cost of a city in Southern Brazil with continuous use medications dispensed by Primary Health Care

Objetivo: Avaliar o custo com medicamentos básicos de uso contínuo de usuários da Atenção Primária em Saúde de Santa Rosa-RS. Métodos: Estudo transversal e analítico realizado em um município do noroeste do Rio Grande do Sul. Foram incluídos usuários cadastrados nas 17 unidades de estratégia de saúde da família, das áreas urbana e rural, em uso de no mínimo um medicamento de uso contínuo. A coleta de dados foi realizada pelo acesso ao sistema informatizado de prescrição eletrônica. Resultados: Foram incluídos 642 usuários, com idade média de 60,40 anos, sendo 64,3% mulheres. Identificou-se média de 4,68 ± 2,82 medicamentos/prescrição e 47,4% ± 14,48 dos usuários em uso de cinco ou mais medicamentos. Dos medicamentos em uso, 87,9% pertencem ao componente básico da assistência farmacêutica. O custo anual do município por usuário de medicamento foi em média de R$ 250,60. O sistema cardiovascular foi o grupo anatômico com maior custo total. Verificou-se maior frequência de uso de medicamentos entre os idosos, que consequentemente representam o grupo etário com maior custo de tratamento. Conclusão: Evidenciou-se que a maioria dos medicamentos prescritos atua sobre os sistemas cardiovascular e nervoso, e pertence ao componente básico da assistência farmacêutica. O custo com medicamentos demonstrou investimento do município de valores 25 vezes maiores do que o mínimo estabelecido pela legislação vigente, com vistas a garantia de acesso ao tratamento e manutenção da qualidade de vida da população assistida.

Objective: The objective of this study was to evaluate the cost of basic medicines for continuous use by users of Primary Health Care in Santa Rosa-RS. Methods: A cross-sectional and analytical study carried out in primary health care in a city in the Northwest of Rio Grande do Sul, comprising 17 unites of Strategies Family Health. Registered users in urban and rural units were included, using at least one continuous treatment. Data collection was performed by accessing the computerized electronic system. Results: 642 users were included in the study, with an average age of 60.40 ± 14.48 years, 64.3% were women. The average number of prescription drugs was 4.68 ± 2.82/prescription and 47.4% of users were using five or more medications. Of the drugs in use, 87.9% belonging to the basic component of pharmaceutical care. These drugs represent an annual cost per user of R$ 250.60. The cardiovascular system presents itself as the anatomical group with the highest total expenditure. Hydrochlorothiazide was the most prescribed drug and beclomethasone represented the highest individual expense. Conclusion: It became evident that most of the drugs prescribed belonged to the basic component of pharmaceutical care and belonged to the cardiovascular and nervous system. Cost of drug implies the investment of the city of 25 times higher than the established by the current legislation, with a view to guaranteeing access to treatment and maintaining the quality of life of the assisted population.

Financiamiento del sistema de salud colombiano: Tendencias y desafíos / Financing of the Colombian health system: Trends and challenges

RESUMEN El financiamiento es una función fundamental que contribuye al propósito que tienen los sistemas de salud de mejorar el estado de salud de la población. Esta función se concreta en la recaudación de fondos, su mancomunación y asignación, y en ella se diferencian las fuentes y los usos de los recursos, especialmente en cuanto al carácter público o privado y a la forma como se cubren los costos de los servicios de salud. En este artículo se presenta una mirada de largo plazo sobre el financiamiento de la salud en Colombia, identificando los antecedentes y la evolución a partir de la reforma de 1993. Se identifican cuatro momentos en esta evolución: I. incremento significativo de recursos, al momento de expedir las Leyes 60 y 100 de 1993; II. contención fiscal, en el marco de la crisis de 1998 y 1999; III. mayor esfuerzo fiscal, especialmente a partir de 2010, y IV. sustitución de fuentes, de cotizaciones a impuestos generales, que se inició en 2012. Se evidencia un desarrollo importante de la función de financiamiento, con un fortalecimiento a partir de la Administradora de los Recursos del Sistema (ADRES), la reducción en la dependencia de las cotizaciones, el proceso de igualación per cápita entre regímenes de aseguramiento, y un mayor aporte de impuestos generales para buscar el equilibrio del sistema. Todo ello implica mantener el predominio público y garantizar la protección financiera en salud.

ABSTRACT Financing is a fundamental function that contributes to the purpose of health systems to improve the health status of the population. This function takes the form of fundraising, pooling and allocation, and it differentiates the sources and uses of resources, especially in terms of their public or private nature and the way in which health costs are covered. This article presents a long-term view of health financing in Colombia, identifying the background and evolution since the 1993 reform. Four moments in this evolution are identified: I. significant increase in resources, at the time of issuing Laws 60 and 100 of 1993; II. fiscal containment, in the context of the 1998 and 1999 crisis; IV. greater fiscal effort, especially since 2010, and V. substitution of sources, from contributions to general taxes, which began in 2012. An important development of the financing function is evident, with a strengthening of the System's Resources Administrator (ADRES), a reduction in the dependence on contributions, the process of equalization of the capita among insurance regimes, and a greater contribution of general taxes to seek the balance of the system, all of which implies maintaining public predominance and guaranteeing financial protection in health.

Does tourism increase CO2 emissions and health spending in Mexico? New evidence from nonlinear ARDL approach.

This study investigates the nexus between tourism, CO2 emissions and health spending in Mexico. We applied a nonlinear ARDL approach for the empirical analysis for the time period 1996-2018. Mexico receives a large number of tourists each year, tourism improves foreign exchange earnings and contributes positively to the economic growth. However, tourist activities impose a serious environmental cost in terms of CO2 emissions which increase health spending. The empirical findings suggest that tourism leads to CO2 emissions which resultantly causes a high level of health spending in Mexico. Both short-run and long-run findings reported a significant positive association between tourism, CO2 emissions, and health expenditures. Therefore, the government needs legislation to reduce CO2 emissions, besides the use of renewable energy could also help to reduce the CO2 emissions and health expenditures in society. This study does not support to reduce the health expenditure, rather it suggests optimal utilization of the funds allocated to the health sector.

Measuring Financial Protection in Health in Brazil: Catastrophic and Poverty Impacts of Health Care Payments Using the Latest National Household Consumption Survey.

This paper measures financial protection in health in Brazil by estimating the incidence and describes the profile of catastrophic expenditures and impoverishment due to household out-of-pocket (OOP) health spending. It uses the latest Brazilian consumption survey (POF 2017/2018) to analyze the composition of household health spending and applies two thresholds of household consumption to identify households facing catastrophic expenditures and impoverishment due to health care payments. Results show that a third of households spend more than 10% of their budget on health, and the share of households facing financial hardship is significantly higher among the Brazilian poor (37% among the bottom consumption deciles). Medicines are the main contributor to component of OOP health spending, reaching 85% of all OOP payments for the lowest consumption deciles. Households with women as household head and those with heads with more years of schooling have higher probability of incurring catastrophic health spending. Yearly, more than 10 million Brazilians are pushed into poverty due to OOP health care payments, which represents a larger percentage of individuals (4.87%) than reported globally (2.5%) or among Latin America and Caribbean countries (1.8%). Conclusions: Despite the achievements in implementing universal health coverage in Brazil, challenges remain to guarantee financial protection to its population (especially the Brazilian poor). Policies to expand access and affordability of essential medicines are key to improve financial protection in health in Brazil.

The effects of health spending on the propagation of infectious diseases.

We explore the discontinuity in the allocation of the main federal grant to Brazilian municipalities to identify the local effects of health spending and the spillovers into the bordering jurisdictions. Fiscal reactions are asymmetric: small neighbors reduce health spending, while we do not find a significant budgetary response in the largest neighbor. Our results suggest a reduction in the spread of infectious diseases in the neighbors, with fewer residents hospitalized with gastrointestinal infections. In addition, the elderly demand less hospitalization in the largest bordering jurisdictions due to respiratory infectious diseases. Finally, we find a direct and significant reduction in infant mortality, consistent with the observed pediatricians' increase, while the spillover effects on neighbors' mortality rates are not conclusive.

Concentración del gasto sanitario en una aseguradora colombiana del régimen subsidiado, 2014 / Concentration of Health Spending in a Subsidized-scheme Colombian Insurance Company, 2014

Resumen Objetivo: Estimar la concentración del gasto sanitario según grupos de patologías y tipos de servicios en una aseguradora subsidiada que afilia personas pobres (estratos socioeconómicos 1 y 2) al Sistema de Salud de Colombia en 2014. Métodos: Se analizó el gasto sanitario en 1 666 477 afiliados, por grupos de patología y tipos de servicios, en el año 2014. Para la descripción de la concentración del gasto se utilizó el coeficiente de Gini y la curva de Lorenz. Resultados: El gasto sanitario de la aseguradora fue de usd 418 millones. De este, el 81 % se aplicó a servicios contenidos en el Plan Obligatorio de Salud (pos). Los grupos de patologías que concentraron el 43,4 % del gasto sanitario fueron cardiovascular (14,3 %), cáncer (7,8 %), enfermedades respiratorias (7,3 %), enfermedades urinarias (7 %) y traumatismos (6,9 %). Los servicios diagnósticos, curativos y de rehabilitación representaron el 77,8 % del gasto sanitario. La hospitalización fue el grupo de servicio que más impactó el costo (47 %), y las consultas, el más utilizado. Las curvas de Lorenz demostraron que el 70 % del gasto en salud se concentra en aproximadamente el 20 % de los afiliados, generando un coeficiente de Gini de 0,58. Conclusión: El diagnóstico y el tratamiento de las enfermedades crónicas no transmisibles concentran una alta proporción del gasto sanitario, lo cual genera una competencia de recursos para servicios preventivos y de promoción de la salud.

Abstract Objective: to estimate the concentration of health spending depending on pathology groups and types of services in a subsidized insurance company which enrolled low-income people (social economic strata 1 and 2) in the Colombian Healthcare System in 2014. Methodology: Health spending was analyzed in 1 666 477 members, set up by pathologies and types of services during 2014. To describe the concentration of health spending, researchers used the Gini coefficient and the Lorenz curve. Results: the health spending of the insurance company was US$418 million. Out of this, 81 % was used in service contained in the mandatory Health Plan (in Spanish, Plan Obligatorio de Salud -POS). The pathology groups that concentrated 43.4% of health spending were cardiovascular (14.3%), cancer (7.8%), respiratory diseases (7.3%), urinary diseases (7%) and trauma (6.9%). Diagnostic, healing and rehabilitation services represented 77.8% of health spending. Hospitalization was the service group with the highest impact on costs (47%), and consultations, the most used. The Lorenz curves showed that 70% of the health spending is concentrated in approximately 20% the Affiliated people, resulting in a 0.58 Gini coefficient. Conclusion: Diagnostic and treatment of chronic non-transmittable diseases concentrate a vast part of health spending, which produces a competition of resources for preventive services and healthcare promotion.

Financiamento público para a saúde de municípios paranaenses em região de fronteiras (2000 - 2016) / Financiación pública para la salud de municipios de Paraná en la región de fronteras (2000 - 2016) / Public funding for health care in municipalities of the state of Paraná located in the border region (2000 - 2016)

RESUMO Objetivo: analisar a trajetória do financiamento público com ações e serviços de saúde em quatro municípios fronteiriços do Paraná/Brasil, no período de 2000 a 2016. Método: pesquisa quantitativa desenvolvida com dados do Sistema de Informação sobre Orçamentos Públicos em Saúde, analisados por meio de estatística descritiva simples. Resultados: os resultados mostram crescimento dos valores absolutos e relativos aplicados em ações e serviços de saúde ao longo do período; maior participação dos municípios no financiamento; e certo reconhecimento da problemática da fronteira pelos governos federal e estadual por meio de programas específicos. Conclusão: o problema do financiamento da saúde em municípios de fronteira não está equacionado no período posterior à promulgação da Emenda Constitucional nº 29, em 2000, face ao subfinanciamento crônico do sistema e da interrupção de programas específicos. Os resultados contribuem para melhor compreensão acerca do direito à saúde dos residentes na fronteira.

RESUMEN Objetivo: evaluar cómo ocurre la financiación pública con acciones y servicios de salud en cuatro municipios de frontera de Paraná/Brasil, en el periodo de 2000 a 2016. Método: investigación cuantitativa desarrollada con datos del Sistema de Información sobre Presupuestos Públicos en Salud, analizados por medio de estadística descriptiva simple. Resultados: los resultados apuntan crecimiento de los valores absolutos y relativos aplicados en acciones y servicios de salud a lo largo del periodo; mayor participación de los municipios en la financiación; y algún reconocimiento de la problemática de la frontera por los gobiernos federal y estadual por medio de programas específicos. Conclusión: el problema de la financiación de la salud en municipios de frontera no fue investigado en el periodo posterior a la promulgación de la Enmienda Constitucional nº 29, en 2000, considerando la subfinanciación crónica del sistema y la interrupción de programas específicos. Los resultados contribuyen para la comprensión acerca del derecho a la salud de las personas que viven en la frontera.

ABSTRACT Objective: To analyze the history of public funding of health actions and services in four bordering municipalities of Paraná/Brazil, from 2000 to 2016. Method: Quantitative study that uses data from the Information System on Public Health Budgets (SIOPS), analyzed through simple descriptive statistics. Results: The results show the growth of absolute and relative values applied in healthcare actions and services over the study period; greater participation of the municipalities in the funding, and a bit of recognition of the issues related to the border region by the federal and state governments, through the implementation of specific programs. Conclusion: The problem of health funding in border municipalities was not solved after the enactment of Constitutional Amendment No. 29, in 2000, due to the chronic underfunding of the system and the discontinuation of specific programs. The results contribute to a better understanding of the right to health of border residents.

Composición del gasto de bolsillo en el sistema de salud del Paraguay / Composition of out-of-pocket health spending in the health system of Paraguay

La protección financiera de la población, con equidad, es un objetivo del sistema de salud. Sin embargo, numerosas personas enfermas incurren en gasto de bolsillo (GBS) para obtener atención, situación que es inequitativa. El objetivo de este artículo fue analizar la composición del GBS, su magnitud y distribución en la población general y pobre. Como metodología se analizó el módulo de salud de la Encuesta Permanente de Hogares del 2014. La población que incurrió en GBS fue el 75,1% de la población enferma, 75,8% para los no pobres, 73,3% para los pobres no extremos y 73,0% para los pobres extremos. El GBS promedio fue de 54,5 USD; 63,3 USD para los no pobres; 26,2 USD para los pobres no extremos y 30,4 USD para los pobres extremos. El 53% del GBS fue por pagos por medicamentos, 22,6% debido a estudios de diagnóstico, 18,7% por hospitalizaciones y 5,7% por consultas. La proporción de GBS por compra de medicamentos fue mayor entre los pobres: 72,3% para los pobres extremos y 68,6% para los pobres no extremos. Si bien el GBS se acumuló 87% entre los no pobres la relación de los precios promedios sobre el ingreso promedio fue más elevado entre los pobres: 95,8% para los pobres extremos, 40,7% para los pobres no extremos y 21,4% para los no pobres, pero los gastos por hospitalizaciones pueden superar el ingreso total. Los resultados señalan inequidad en el financiamiento del sistema de salud paraguayo.

Financial protection with equity for the population is an objective of the health system. However, many sick people incur pocket expenses to obtain care, a situation that is inequitable. The objective of this article is to analyze the composition of pocket expenses, its magnitude and distribution in the general and poor population. As a methodology, the health module of the Permanent Household Survey for 2014 was analyzed. The population that incurred in pocket expenses was 75.1% of the sick population, 75.8% of the non-poor, 73.3% of the non-extreme poor, and 73.0% of the extreme poor. The average pocket expenses was 54.5 USD, 63.3 USD for non-poor, 26.2 USD for non-extreme poor and 30.4 USD for extreme poor. Fifty three percent of the pocket expenses were for payments of medicines, 22.6% due to diagnostic studies, 18.7% for hospitalizations and 5.7% for consultations. The proportion of pocket expenses per drug purchase was higher among the poor: 72.3% for the extreme poor and 68.6% for the non-extreme poor. While pocket expenses accounted for 87.0% of the non-poor incomes, the ratio of average prices to average income was higher among the poor: 95.8% for extreme poor, 40.7% for non-extreme poor, and 21, 4% for non-poor, but hospitalization expenses may exceed total income. These data indicate inequity in the financing of the Paraguayan health system.

Financiamento do Sistema Único de Saúde nos governos FHC, Lula e Dilma / Funding of the Unified Health System in FHC, Lula and Dilma government

O artigo discute questões relativas ao financiamento e à alocação de recursos no SUS, no contexto de dois projetos políticos distintos. O estudo analisa os gastos com saúde no Brasil, no período de 1995 a 2012, comparados aos gastos internacionais, ao PIB e a Receita Corrente Bruta. Na análise, buscou-se comparar os compromissos assumidos com o SUS nas gestões dos presidentes FHC, Lula e Dilma. Observou-se que, com relação ao comportamento dos gastos com saúde, no âmbito federal, os governos do Partido dos Trabalhadores não diferiram dos governos do Partido da Social Democracia Brasileira. O perfil dos gastos com saúde não deu conta de atender ao sonho da reforma sanitária dos anos 1980.

This article discusses issues related to funding and resource allocation in the SUS, in the context of two different projects policies. The study analyzed health spending in Brazil, in the period 1995 to 2012, compared to international spending, the Gross Domestic Product and Current Federal Gross Revenue. In the analysis, we compared the commitments made to the SUS in the administrations of Presidents FHC, Lula and Dilma. It was observed that, in relation to the behaviour of health spending, the Federal Governments of the Workers' Party did not differ from the Governments of the Brazilian Social Democracy Party. The profile of health spending didn't realize the dream of health reform in the years 1980.

Gasto do Ministério da Saúde com medicamentos: tendência dos programas de 2002 a 2007 / Gasto del Ministerio de la Salud con medicamentos: tendencia de los programas de 2002 a 2007 / Ministry of Health's spending on drugs: program trends from 2002 to 2007

OBJETIVO: Analisar a evolução do gasto do Ministério da Saúde com medicamentos. MÉTODOS: O gasto total (agregado) do Ministério da Saúde com medicamentos e de seus programas (desagregado) foram analisados para o período de 2002 a 2007. As ações que financiaram a aquisição de medicamentos foram obtidas no sistema Siga Brasil e classificadas segundo os programas de assistência farmacêutica. Os valores liquidados foram identificados para cada programa. Para 2006 e 2007, foram pesquisadas as aquisições de anti-retrovirais. Em relação aos medicamentos do Programa de Dispensação em Caráter Excepcional, confrontaram-se os dados da ação orçamentária com aqueles disponíveis no Sistema Único de Saúde. Os valores obtidos foram deflacionados aplicando-se o Índice de Preços ao Consumidor Amplo. Foi efetuada análise exploratória dos dados. RESULTADOS: O gasto em 2007 foi 3,2 vezes o de 2002 e a participação do gasto com medicamentos no gasto total aumentou de 5,4 por cento em 2002 para 10,7 por cento em 2007. O gasto com os medicamentos da atenção básica teve aumento de 75 por cento e com medicamentos dos programas estratégicos, de 124 por cento. No caso dos anti-retrovirais o aumento foi de aproximadamente 6 por cento, mas com aumento de 77 por cento de 2005 a 2006, seguida de redução de 29 por cento de 2006 a 2007. O aumento mais expressivo do gasto foi observado com os medicamentos de dispensação em caráter excepcional, 252 por cento de 2003 a 2007. CONCLUSÕES: Houve aumento significativo do gasto com medicamentos entre 2002 e 2007, havendo maior participação nesse gasto dos anti-retrovirais e medicamentos de dispensação excepcional, os quais são constituídos por número expressivo de fármacos protegidos por patentes.