ABSTRACT
Background: As of December 31, 2020, Brazil had the second-highest burden of COVID-19 worldwide. Given the absence of federal government coordination, it was up to the local governments to maintain healthcare provision for non-COVID health issues. In this descriptive study, we aimed to discuss the SUS functionality and resilience, describing the impact of the pandemic on non-COVID health services delivery while considering the regional inequalities of the allocation of financing health system, health infrastructure and health workforce. Methods: We used input-output framework based on the World Health Organization (WHO) Health System Building Blocks to estimate health system functionality and resilience. An ecological assessment was designed to calculated mean relative changes to compare the first year of the pandemic in Brazil with the previous one. All data used in this study were anonymized and made available by the Brazilian Ministry of Health. Input indicators were categorized in health system financing (federal funding received as well as expenditure of both state and city governments), health system's infrastructure (hospital beds) and health workforce (healthcare workers positions). Output indicators were categorized into nine different groups of service delivery procedures. To explore the relationship between the variation in procedures with socioeconomic conditions, we used the Socioeconomic Vulnerability Index (SVI). Findings: State governments had a 38·6% increase in federal transfers, while municipal governments had a 33·9% increase. The increase of ICU beds reached its peak in the third quarter of 2020, averaging 72·1% by the end of the year. The country also saw an increase in jobs for registered nurses (13·6%), nurse assistants (8·5%), physiotherapists (7·9%), and medical doctors (4·9%). All procedures underwent expressive reduction: Screenings (-42·6%); Diagnostic procedures (-28·9%); Physician appointments (-42·5%); Low and medium complexity surgeries (-59·7%); High complexity surgeries (-27·9%); Transplants (-44·7%); Treatments and clinical procedures due to injuries of external causes (-19·1%); Irrepressible procedures (-8·5%); and Childbirths (-12·6%). The most significant drop in procedures happened in the first quarter of the pandemic, followed by progressive increase; most regions had not yet recovered by the end of 2020. State-level changes in numbers of procedures point towards a negative trend with SVI. Interpretation: The Brazilian Government did not consider that socioeconomically vulnerable states were at a higher risk of being impacted by the overburden of the health system caused by the COVID-19, which resulted in poorer health system functionality for those vulnerable states. The lack of proper planning to improve health system resilience resulted in the decrease of a quarter of the amount of healthcare procedures increasing the already existing health disparities in the country. Funding: MCTIC/CNPQ/FNDCT/MS/SCTIE/DECIT No 07/2020.
ABSTRACT
Introdução: os gastos com ações de saúde, realizados pelos municípios brasileiros, apresentaram elevado incremento nos últimos sete anos, dentre os quais se destaca aquele com medicamentos. Soma-se a essa constatação, o descumprimento das aplicações constitucionais mínimas em saúde por parte da União e dos Estados, paralelamente à verificação de recordes de arrecadação. Sob a ótica epidemiológica, o contexto é de crescente prevalência de doenças crônicas não transmissíveis, decorrentes do envelhecimento populacional. Analisar os orçamentos municipais em saúde constitui-se, portanto, como instrumento relevante para qualificar essa discussão acerca da sobrecarga imprimida aos municípios atualmente. Objetivo: Analisar a despesa empenhada com saúde pela administração direta das capitais brasileiras, segundo região geográfica, com enfoque na aquisição de medicamentos, entre os anos de 2001 a 2005. Metodologia: As informações foram obtidas em bancos de dados oficiais brasileiros. Os gastos em saúde, obtidos pelo SIOPS, foram deflacionados pelo Índice Nacional de Preços ao Consumidor, tomando-se 2001 como ano base. As despesas foram detalhadas segundo os elementos de despesa: pessoal, material hospitalar, material de consumo, pessoa jurídica. Foram também estabelecidas as composições percentuais dos orçamentos, calculadas as médias, variações acumuladas, e gasto com per capita com medicamento. Resultados: observou-se incremento de 61.96% do gasto com medicamento, três vezes superior ao incremento nos gastos totais com saúde, 22,71%, tendo as maiores variações sido verificadas nos anos de eleições municipais. Conclusão: os resultados apontam para o maior peso dos gasto com saúde sobre os municípios após a descentralização do SUS, para a insuficiência da parte variável do PAB destinada à assistência farmacêutica básica, e para a possibilidade de a política de assistência farmacêutica nos municípios serem condicionadas por critérios não técnicos.
Introduction: the health expenditure of Brazilian municipalities has increased in the last seven years, which are highlighted by drugs expenditure. Therefore, the Health Unify Systems (SUS) financing is held in context of disrespect by the federal government and states, about the minimum percentage of resources applied to public health, established by the Federal Constitution, besides the· several records of federal government collect. By the epidemiological aspect, the municipalities are being pressed by the trend of high prevalence of chronic diseases, caused by the aging of populations. Therefore, to analyze the municipalities' budget is a way to qualify the health overcharge municipality's comprehension nowadays. Objective: to analyze the expenditures of health by the administration's capitals, by political regions, focusing on the purchase of drugs between 2001-2005. Methodology: the data used in this study was provided by official database. The budget data was obtained by SIOPS, adjusted by the National Consumer Index Price (INPC) of Instituto Brasileiro de Geografia e Estatística (IBGE), taking the year of 2005 as the base for comparison. These expenditures were separated by items: payroll, hospital material, drugs, legal entity, and the total of expenditures. The amount over budget, the mean proportional, the accumulated variation, and the per capita drug expenditure of each of these items were calculated. Results: It was observed that 61,96% of accumulated variation of drug expenditure and 22,71% of the total budget, and the highest values of the period were noted in years of municipality's elections. Conclusion: the results pointed out into three trends: the bigger wages of health expenditures remained over the municipalities after the SUS decentralization; the variable PAB's part of directed pharmaceutical assistance is insufficient actually; and the pharmaceutical political possibility to be ruled by non technical criterion.
