Sustentabilidade do SUS e renúncia de arrecadação fiscal em saúde / Financial sustainability of the Brazilian Health System and health-related tax expenditures

Resumo Este artigo estimou o gasto tributário em saúde tendo como base os dados oficiais da Receita Federal do Brasil entre 2003 e 2015. O Ministério da Saúde poderá assim avaliar o papel de tais subsídios no contexto do subfinanciamento do Sistema Único de Saúde. Para a análise dos dados, articularam-se dois eixos teóricos: os estudos relacionados à economia política da saúde e às finanças públicas. Vale dizer, ao lado da dimensão empírica do trabalho, se privilegiou a avaliação das políticas de saúde no campo do financiamento setorial. Os resultados apontam que o subsídio associado aos planos de saúde atingiu o montante de R$ 12,5 bilhões em 2015, o que poderia ampliar a alocação de recursos financeiros na atenção primária e nos bens e serviços de média complexidade tecnológica.

Abstract Using official data from Brazil's Internal Revenue Service, this article estimates health-related federal tax expenditures between 2003 and 2015. The Ministry of Health will thus be able to assess the relevance of these subsidies within a context of gross underfunding of Brazil's public health system. The analysis was built around concepts and theories developed in the fields of political economy and public finance, focusing on policies directed at public funding of the health sector. The results show that tax expenditures associated with health insurance plans was R$12.5 billion in 2015. It is suggested that these resources could be put to better use in public primary care and medium-complexity care services.

Smokeless tobacco product prices and taxation in Bangladesh: Findings from the International Tobacco Control Survey.

INTRODUCTION: Smokeless tobacco use occupies a significant portion of overall tobacco consumption in Bangladesh. Yet very little is known about the effectiveness of tax and price policy in controlling the use of smokeless tobacco use in the country. METHODS: The paper examines the price distribution of various smoked (cigarette, bidi) and smokeless tobacco products (zarda, gul) using the univariate Epanechnikov kernel density function. It estimates the own and cross price elasticity of demand for the most widely used smokeless tobacco product zarda using twostep regression analysis. The analysis is based on data from the ITC Bangladesh Wave 3 Survey which is a nationally representative cohort survey of tobacco users and nonusers conducted in in Bangladesh during 2011-12. RESULTS: The price elasticity of lower price brands of zarda is estimated at −0.64 and of higher priced brands at −0.39, and the cross price elasticity of zarda with respect to cigarette price at 0.35. The tax increase on smokeless tobacco needs to be greater than the tax increase on smoked tobacco to bridge the wide price differential between the two types of products that currently encourages downward substitution from smoked to smokeless tobacco and discourages quitting behavior. CONCLUSIONS: This paper argues that increasing tax on smokeless tobacco simultaneously with the tax increase on smoked tobacco can have significant negative impact on the prevalence of smokeless tobacco use in Bangladesh. Finally, a specific excise system replacing the existing ad valorem excise tax can substantially contribute to the revenue collection performance from smokeless tobacco products.

Economic policies for tobacco control in developing countries

Elevar impuestos al tabaco también puede provocar en la población un impacto de división. La recaudación de impuestos al tabaco se ha elevado desde que las personas de bajo nivel socio-económico fuman cada vez más y, de hecho, son los que más contribuyen al total de la recaudación. Esto significa que los impuestos son regresivos. Sin embargo, el impuesto al tabaco es probable que vaya en aumento, y con ello disminuiría la incidencia relativa de impuestos a la pobreza en relación con la riqueza. Esto se basa en la premisa de que la población de escasos recursos es más sensible a los cambios del precio del tabaco y, por tanto, reduciría su consumo, en comparación con lo que sucede en el porcentaje de la población de altos recursos respecto a un aumento del impuesto-inducido en el tabaco. Los estudios empíricos recientes confirman esta hipótesis y demuestran que el precio del cigarrillo experimenta un aumento con las ganancias. La investigación en China ratifica que reduciendo el consumo de cigarros se podrían ingresar mayores recursos para alimentación y sustento a las familias, así como otros productos que ayuden a incrementar su nivel de vida. Por lo tanto, a largo plazo, las medidas para el control de tabaco reducirían la inequidad social.