ABSTRACT
Resumo O objetivo deste artigo é analisar a distribuição dos recursos financeiros federais para os municípios do estado da Bahia, em 2010, na perspectiva da equidade. A metodologia utilizou o modelo "Contas Nacionais de Saúde" para identificação do fluxo de recursos; o Índice de Desenvolvimento Humano Municipal (IDHM) como proxy das necessidades de saúde; e indicadores de oferta de serviços de saúde por macrorregião. As transferências federais totalizaram R$ 2 bilhões, R$ 146,36 per capita, sendo 20% dos recursos destinados aos 219 municípios com menor IDHM. Os 37 municípios com melhor IDHM detiveram 60% dos recursos, ou seja, mais de R$ 1,23 bilhões. Evidenciou-se que 30% dos recursos (R$ 615,45 milhões) foram destinados a 40% da população do estado, espalhada por 348 municípios, e mais de R$ 1 bilhão foi transferido também para 40% da população, mas que se distribuía por apenas 17 municípios. A mais populosa das nove macrorregiões e de maior capacidade instalada recebeu, sozinha, 32,81% dos recursos. A macrorregião com mais equipes de saúde por habitante tinha o segundo melhor IDHM. Verificou-se grande concentração de recursos destinada a poucos municípios de grande porte populacional e com os mais altos IDHM, e fraco aporte para regiões com maiores necessidades de saúde.
Abstract This article aims to analyze the distribution of federal funding for the municipalities of the state of Bahia, in 2010, from the perspective of equity. The methodology used Brazil's "National Health Care Accounts" model to identify the flow of funds; Municipal Human Development Index (MHDI) as a proxy for health care needs; and health care supply indicators by macro-regions. Federal transfers totaled R$ 2 billion, R$ 146.36 per capita, 20% of these funds being destined to the 219 municipalities with the lowest MHDI indices. The 37 municipalities with the best MHDI indices received 60% of the funds; that is, over R$ 1.23 billion. 30% of the funds (R$ 615.45 million) were found to be destined to 40% of the state population spread through 348 municipalities, and over R$ 1 billion was also transferred to 40% of a population distributed through only 17 municipalities. The most populous region in the nine macro-regions, which also had the highest installed capacity, received 32.81% of the funds alone. The macro-region with the highest number of health care teams per inhabitant had the second best MHDI. A great concentration of funds was found to be destined to few municipalities with large populations and the highest MHDI indices, but smaller regions with higher health care needs received a low volume of funds.
Subject(s)
Humans , Male , Female , Health Care Economics and Organizations , Unified Health System , Health Expenditures , Health Equity , Resource Allocation , Health Policy , Health Services , Regional Health Planning , Politics , Health PromotionABSTRACT
Aim: The financial burden of malignant diseases treatment has increased remarkably over the years. This is due to, among many reasons, the costs of drugs, especially those of the new classes. Thus, it is of interest to assess the availability and differential cost of anti-cancer drugs in developing countries compared to developed countries. Study Design: The study was designed to determine the anti-cancer drugs availability in the world, in the United States of America (USA), the United Kingdom (UK) and the Republic of Serbia (RS), with the aim to get insights into the similarities and differences between developed and developing countries toward anti-cancer drugs availability, as well as the prices of these drugs. This analysis was based on three drug data bases for anti-cancer drugs that were available during 2011 and 2012 year in the world, USA, UK, and RS. Results: About 37% of anti-cancer drugs that were present in the world market in 2011 year were also present in the RS (the drugs that were reimbursed by the state health insurance), compared to 74.8 and 67.4% that were available in the USA and the UK, respectively. Furthermore, out of all drugs registered in 2012 in the UK, 62.8% were present in the RS and almost all pharmacological groups were represented with some drugs, including very expensive ones like the biological agents. Most of the drugs in the RS were cheaper, regardless of whether they belonged to nonproprietary or brand-name drugs. These findings could be the result of the very low national gross domestic product in the RS and thus, the small funds earmarked for the health care. Conclusion: The Republic of Serbia, which belongs to developing countries, face some difficulties in taking care of patients with malignant diseases where the prominent place have drugs for malignant diseases treatment, especially the newer classes, which are usually more expensive and generally do not provide the first-line treatment.