[Effects of parliamentary amendments on municipal financing of primary health care in the Brazilian Unified National Health System]. / Efeitos das emendas parlamentares no financiamento municipal da atenção primária à saúde do Sistema Único de Saúde.

This study aims to analyze the effects of the expansion of the federal transfer of parliamentary amendments for municipal financing of primary health care (PHC) in the Brazilian Unified National Health System (SUS), from 2015 to 2020. A longitudinal study was conducted using secondary data on transfers of parliamentary amendments from the Brazilian Ministry of Health and expenditure of municipalities' own resources on public health actions and services and PHC. The effect of the transfer of parliamentary amendments on municipal financing was verified in a stratified way by population size of the municipalities, using generalized estimating equation models. The transfer of parliamentary amendments for PHC showed a large discrepancy in per capita values among municipalities of different population sizes. No correlation with municipal spending on public health actions and services was observed in municipalities with more than 10,000 inhabitants, and the association with spending on PHC (p < 0.050) was inverse in all municipalities. Therefore, the increase in the transfer of parliamentary amendments by the Brazilian Ministry of Health favored a reduction in the allocation of municipal revenues to PHC, which may have been directed to other spending purposes in the SUS. These changes seem to represent priorities established for municipal budget expenditure, which have repercussions on local conditions for guaranteeing stable funding for PHC in Brazil.

O objetivo deste artigo é analisar os efeitos da ampliação do repasse federal de emendas parlamentares no financiamento municipal da atenção primária à saúde (APS) do Sistema Único de Saúde (SUS), no período de 2015 a 2020. Foi realizado estudo longitudinal com dados secundários de transferências por emendas parlamentares do Ministério da Saúde e de despesas com recursos próprios dos municípios, aplicadas em ações e serviços públicos de saúde e na APS. O efeito do repasse de emendas parlamentares no financiamento municipal foi verificado de forma estratificada por porte populacional dos municípios, por meio de modelos de equações de estimativas generalizadas. O repasse de emendas parlamentares para a APS apresentou grande discrepância de valores per capita entre os municípios de diferentes portes populacionais. Observou-se inexistência de correlação com a despesa municipal em ações e serviços públicos de saúde nos municípios com mais de 10 mil habitantes e associação inversa com a despesa em APS (p < 0,050) em todos os grupos. Conclui-se que o aumento do repasse de emendas parlamentares pelo Ministério da Saúde favoreceu a redução da alocação de receitas municipais com APS, que podem ter sido direcionados para outras finalidades de gasto no SUS. Tais mudanças parecem refletir prioridades estabelecidas para a despesa orçamentária dos municípios, que repercutem sobre as condições locais para a garantia da estabilidade do financiamento da APS no Brasil.

El artículo tiene como objetivo analizar los efectos de la ampliación de la transferencia de recursos federal de enmiendas parlamentarias sobre el financiamiento municipal de la atención primaria de salud (APS) en el Sistema Único de Salud brasileño (SUS), en el período del 2015 al 2020. Se realizó un estudio longitudinal con datos secundarios de transferencias de recursos por enmiendas parlamentarias del Ministerio de Salud y de gastos con recursos propios de los municipios, aplicados a acciones y servicios públicos de salud y a la APS. El efecto de la transferencia de recursos de enmiendas parlamentarias sobre el financiamiento municipal se verificó de forma estratificada por tamaño de población de los municipios, utilizando modelos de ecuaciones de estimaciones generalizadas. La transferencia de recursos de enmiendas parlamentarias para la APS mostró una gran discrepancia en los valores per cápita entre municipios de diferente tamaño poblacional. No hubo correlación con el gasto municipal en acciones y servicios públicos de salud en aquellos con más de 10.000 habitantes y asociación inversa con el gasto en APS (p < 0,050) en todos los grupos de municipios. Se concluye que el aumento en la transferencia de recursos de enmiendas parlamentarias por parte del Ministerio de Salud favoreció la reducción de la asignación de ingresos municipales a la APS, que pueden haber sido dirigidos a otros fines de gasto en el SUS. Tales cambios parecen reflejar prioridades establecidas para el gasto presupuestario municipal, que repercuten en las condiciones locales para garantizar la estabilidad del financiamiento de la APS en Brasil.

PEPFAR Reauthorization by Congress Urgent for Global Health.

This Viewpoint discusses the importance of the US Congress reauthorizing funding for the President's Emergency Plan for AIDS Relief, a program developed in 2003 that has played a critical role in fighting HIV/AIDS worldwide as well as other emerging infections and noncommunicable diseases.

White House budget includes push to eliminate hepatitis C.

$11.3 billion would go to treatment, testing, and education.

Influence of the size of the cities of birth and residence in the sports career: an analysis through the bolsa-atleta program / Influência do tamanho das cidades de nascimento e residência na carreira desportiva: uma análise por meio do programa bolsa-atleta

ABSTRACT This study aimed to verify whether the size of municipalities in which Brazilian high-performance athletes are born or live influences the federal government subsidy, in addition to pointing out whether factors such as human development index, demographic density and municipal investment in sports also exert influence. The sample consisted of 2,033 Brazilian municipalities that had athletes, born or resident, receiving the Brazilian incentive Bolsa-Atleta program. The size of municipalities influences the amount and level of grant obtained, demonstrating that the smaller the population size, the lower the chance of obtaining a higher grant level. In addition, factors such as human development index, demographic density and investment in sport influence the acquisition of grants by athletes, mainly by resident athletes, which shows an internal sports migration in the country as a result.

RESUMO O presente estudo teve por objetivo verificar se o tamanho dos municípios em que os atletas brasileiros de rendimento nascem ou residem gera influência na obtenção de subsídio pelo governo federal, além de apontar se fatores como índices de desenvolvimento humano, densidade demográfica e investimento municipal no esporte também exercem influência. A amostra consistiu em 2033 municípios brasileiros que apresentaram atletas nascidos ou residentes contemplados pelo programa de incentivo brasileiro Bolsa-Atleta. Por meio da análise, pode-se verificar que o tamanho dos municípios influência na quantidade e no nível de bolsa obtido, demonstrando que quanto menor o tamanho da população, menor a chance de se obter um nível mais alto de bolsa. Além disto, pode-se notar que fatores como índices de desenvolvimento humano, densidade demográfica e investimento no esporte exercem influência na aquisição de bolsas pelos atletas, principalmente, por parte de atletas residentes, o que evidencia uma migração esportiva interna no país.

The effect of different government subsidies on total-factor productivity: Evidence from private listed manufacturing enterprises in China.

Private enterprises play an increasingly important role in China. They can improve the total-factor productivity (TFP) and help transform and upgrade industrial structures. This study uses data for private listed manufacturing companies from 2009 to 2017 to examine the effects of different types of subsidies on TFP. We also analyze the heterogeneity and specific mechanism of subsidy effects. We find that R&D subsidies and production subsidies positively affect private enterprises' TFP. Moreover, R&D subsidies and production subsidies lagged by one period can also significantly increase private enterprises' TFP. In terms of industry, R&D subsidies have more obvious effects on technology-intensive industries, while production subsidies have more significant effects on labor-intensive and capital-intensive industries. In terms of scale, R&D subsidies' effects on the TFP of medium-sized enterprises are the largest, while production subsidies have the greatest effect on small enterprises' TFP. Government subsidies increase private enterprises' TFP through two mechanisms: improving technological innovation capability and alleviating financing constraints. Our results suggest that governments should formulate different subsidy policies according to industry and enterprise scale.

Realizing Public Rights Through Government Patent Use.

A substantial portion of biomedical R&D is publicly funded. But resulting medicines are typically covered by patents held by private firms, and priced without regard to the public's investment. The Bayh-Dole Act provides a possible remedy, but its scope is limited.

Government strategies to ensure the human right to adequate and healthy food facing the Covid-19 pandemic in Brazil. / Estratégias governamentais para a garantia do direito humano à alimentação adequada e saudável no enfrentamento à pandemia de Covid-19 no Brasil.

The Covid-19 pandemic revealed a concrete and immediate threat to food and nutrition security (FNS), especially for vulnerable groups. This study aimed to identify government strategies implemented in Brazil to provide the Human Right to Adequate and Healthy Food in high social vulnerability contexts during the Covid-19 pandemic. A cross-sectional study was carried out, with analysis of official documents published between March 20 and July 30, 2020, by the Federal Government, Federal District, Brazilian states, and capitals, focusing on measures to ensure availability and physical or financial access to food. Strategies implemented mainly involve food distribution and minimum income assurance. The following were implemented: Basic Emergency Income (Federal Government); Food Acquisition Program (PAA), and emergency financial aid (states); emergency food donation programs (states and municipalities). Existing measures were adapted to the pandemic, such as the National School Food Program (PNAE), the National Food Acquisition Program (PAA), and the distribution of food and staple food baskets. While essential, these strategies have limited scope and are insufficient to ensure FNS.

A pandemia de Covid-19 revelou a existência de ameaça concreta e imediata à segurança alimentar e nutricional (SAN), em especial de grupos vulnerabilizados. O estudo buscou identificar as estratégias governamentais implementadas no Brasil para prover o Direito Humano à Alimentação Adequada e Saudável em contextos de elevada vulnerabilidade social frente à Covid-19. Foi realizado um estudo transversal, com análise de documentos oficiais publicados entre 20 de março e 30 de julho de 2020 pela União, Distrito Federal, estados e capitais brasileiras, com foco em medidas que assegurem disponibilidade e acesso físico ou financeiro a alimentos. As estratégias implementadas envolvem fundamentalmente distribuição de alimentos e garantia de renda mínima. Foram instituídas: Renda Básica Emergencial (União); Programa de Aquisição de Alimentos (PAA) e auxílio financeiro emergencial (estados); programas de doação emergencial de alimentos (estados e municípios). Medidas existentes foram adaptadas frente à pandemia, como o Programa Nacional de Alimentação Escolar (PNAE), o Programa de Aquisição de Alimentos (PAA) nacional, a distribuição de alimentos e de cestas básicas. Embora importantes, essas estratégias têm alcance limitado e são insuficientes para assegurar a SAN.

Estratégias governamentais para a garantia do direito humano à alimentação adequada e saudável no enfrentamento à pandemia de Covid-19 no Brasil / Government strategies to ensure the human right to adequate and healthy food facing the Covid-19 pandemic in Brazil

Resumo A pandemia de Covid-19 revelou a existência de ameaça concreta e imediata à segurança alimentar e nutricional (SAN), em especial de grupos vulnerabilizados. O estudo buscou identificar as estratégias governamentais implementadas no Brasil para prover o Direito Humano à Alimentação Adequada e Saudável em contextos de elevada vulnerabilidade social frente à Covid-19. Foi realizado um estudo transversal, com análise de documentos oficiais publicados entre 20 de março e 30 de julho de 2020 pela União, Distrito Federal, estados e capitais brasileiras, com foco em medidas que assegurem disponibilidade e acesso físico ou financeiro a alimentos. As estratégias implementadas envolvem fundamentalmente distribuição de alimentos e garantia de renda mínima. Foram instituídas: Renda Básica Emergencial (União); Programa de Aquisição de Alimentos (PAA) e auxílio financeiro emergencial (estados); programas de doação emergencial de alimentos (estados e municípios). Medidas existentes foram adaptadas frente à pandemia, como o Programa Nacional de Alimentação Escolar (PNAE), o Programa de Aquisição de Alimentos (PAA) nacional, a distribuição de alimentos e de cestas básicas. Embora importantes, essas estratégias têm alcance limitado e são insuficientes para assegurar a SAN.

Abstract The Covid-19 pandemic revealed a concrete and immediate threat to food and nutrition security (FNS), especially for vulnerable groups. This study aimed to identify government strategies implemented in Brazil to provide the Human Right to Adequate and Healthy Food in high social vulnerability contexts during the Covid-19 pandemic. A cross-sectional study was carried out, with analysis of official documents published between March 20 and July 30, 2020, by the Federal Government, Federal District, Brazilian states, and capitals, focusing on measures to ensure availability and physical or financial access to food. Strategies implemented mainly involve food distribution and minimum income assurance. The following were implemented: Basic Emergency Income (Federal Government); Food Acquisition Program (PAA), and emergency financial aid (states); emergency food donation programs (states and municipalities). Existing measures were adapted to the pandemic, such as the National School Food Program (PNAE), the National Food Acquisition Program (PAA), and the distribution of food and staple food baskets. While essential, these strategies have limited scope and are insufficient to ensure FNS.

Hospital Taxes, Medicaid Supplemental Payments, and State Budgets.

The federal Medicaid statute provides states an incentive to tax hospitals (even otherwise tax-exempt ones) as a means of raising revenue and then leverage federal matching funds by returning at least some of the tax back to the hospitals in the form of Medicaid supplemental payments. The potential for supplemental payments is attractive to hospitals, especially those struggling to recoup the costs of treating Medicaid and uninsured patients, and has resulted in political support from hospitals for states to create hospital "taxes" in name only-hospitals and states both end up with more money than they did when they started because of the federal match. When state officials begin to perceive, however, that nonprofit hospitals may be serving private rather than public interests, they are able to use these hospital taxes as a way to incrementally chip away at the historic governmental support provided through tax exemption by redirecting the revenue raised from the hospital tax to general fund purposes rather than Medicaid supplemental payments. This article looks at how states have been using hospital taxes and supplemental payments to balance state budgets and whether this practice is consistent with the Medicaid program objectives that make the taxes politically feasible.

The financial and employment effects of coronavirus disease 2019 on physicians in the United States.

Although the coronavirus disease 2019 (COVID-19) pandemic has created havoc with the U.S healthcare system and physicians, the financial and contractual implications for physicians are now beginning to come to the forefront. Financial assistance from the federal government has mainly been received by hospitals, which have borne the brunt of the COVID-19 illness. Some physician groups have, or are, receiving assistance through a few programs, although the accelerated and advance payments have been suspended. Employed surgeons are now being furloughed, terminated, or persuaded to agree to a significant cut in pay, forego bonuses, or take leave without pay as healthcare systems and some physician groups have started to experience the consequences of halting elective procedures. Newly hired surgeons might be forced in a few cases to agree to delays in starting their employment, new amendments, changes in employment status, and other terms for fear of losing their employment. In the present report, we have explained some agreement terminology and options available to allow physicians to understand the terms of their employment agreement and make their decisions after consulting with an expert healthcare attorney.

Legal Feasibility and Implementation of Federal Strategies for a National Retail-Based Fruit and Vegetable Subsidy Program in the United States.

Policy Points Suboptimal intake of fruit and vegetables is associated with increased risk of diet-related diseases. A national retail-based fruit and vegetable subsidy program could broadly benefit the health of the entire population. Existing fruit and vegetable subsidy programs can inform potential implementation mechanisms; Congress's powers to tax, spend, and regulate interstate commerce can be leveraged to create a federal program. Legal and administrative feasibility considerations support a conditional funding program or a federal-state cooperative program combining regulation, licensing, and state or local options for flexible implementation strategies. Strategies to engage key stakeholders would enable the program to utilize lessons learned from existing programs. CONTEXT: Suboptimal intake of fruit and vegetables (F&Vs) is associated with increased risk of diet-related diseases. Yet, there are no US government programs to support increased F&V consumption nationally for the whole population, most of whom purchase food at retail establishments. To inform policy discussion and implementation, we identified mechanisms to effectuate a national retail-based F&V subsidy program. METHODS: We conducted legal and policy research using LexisNexis, the UConn Rudd Center Legislation Database, the Centers for Disease Control and Prevention Chronic Disease State Policy Tracking System, the US Department of Agriculture's website, Congress.gov, gray literature, and government reports. First, we identified existing federal, state, local, and nongovernmental organization (NGO) policies and programs that subsidize F&Vs. Second, we evaluated Congress's power to implement a national retail-based F&V subsidy program. FINDINGS: We found five federal programs, three federal bills, four state laws, and 17 state (including the District of Columbia [DC]) bills to appropriate money to supplement federal food assistance programs with F&Vs; 74 programs (six multistate, 22 state [including DC], and 46 local) administered by state and local governments and NGOs that incentivize the purchase of F&Vs for various subpopulations; and two state laws and 11 state bills to provide tax exemptions for F&Vs. To create a national F&V subsidy program, Congress could use its Commerce Clause powers or its powers to tax or spend, through direct regulation, licensing, taxation, tax incentives, and conditional funding. Legal and administrative feasibility considerations support a voluntary conditional funding program or, as a second option, a mandatory federal-state cooperative program combining regulation and licensing. CONCLUSIONS: Multiple existing programs provide an important foundation to inform potential implementation mechanisms for a national F&V subsidy program. Results also highlight the value of state and local participation to leverage existing networks and stakeholder knowledge.