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[Financing the public health services. 1967]
Rodolfo Dos Santos Mascarenhas1
1Cadeira de Administração Sanitária, Faculdade de Higiene e Saúde Pública, Universidade de São Paulo, Brasil.
Revista De Saude Publica
|October 26, 2006
Summary
Brazilian states collect more taxes than the federal government, yet municipal governments receive minimal tax returns. Public health spending varies significantly across states, with per capita costs declining in many regions, necessitating better planning.
Area of Science:
- Public Health Policy
- Fiscal Federalism
- Socioeconomic Analysis
Background:
- Brazilian states collectively collect more taxes than the federal Union, with significant disparities concentrated in a few states like Guanabara and São Paulo.
- Municipal governments receive a disproportionately small share of tax revenue (5.6% in 1962), impacting their capacity to fund public services.
- The existing competence system for Public Health Services across central, regional, and local levels is intrinsically linked to the Brazilian tributary system.
Discussion:
- Public Health Services expenditure per capita in Brazil increased from US$1.82 in 1955 to US$2.30 in 1962, yet its share of total government expenditure decreased from 5.6% to 4.5%.
- Federal spending on Public Health was 36.4%, states 59.3%, and municipalities only 5.5% in 1962, highlighting a significant imbalance in financial responsibility.
- There are vast disparities in Public Health expenditure distribution among Brazilian states, with per capita spending varying dramatically, from Cr$70 in Maranhão to Cr$5,217 in Guanabara in 1964.
Key Insights:
- A substantial portion of Brazilian states (20 out of 27) experienced a decline in per capita public health expenditure between 1954 and 1964.
- The current fiscal structure limits municipal capacity for public health initiatives, despite their role in local service delivery.
- Lack of rational public accounting systems hinders reliable data for international comparisons and effective policy-making.
Outlook:
- Effective reform of the Public Health Services system necessitates concurrent modification of the Brazilian tributary system to ensure equitable revenue distribution.
- Future planning for public health services requires careful consideration of per capita spending trends and regional disparities.
- Development of a rational public accounting system is crucial for evidence-based policymaking and accurate assessment of public health investments.
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