The objective of this article is to offer those responsible for the Peruvian health rectorship reflections on sectoral policy derived from the study of the country’s National Health Accounts (1995-2014). While it is true that the country has increased its spending on health from 4.4 to 5.2% of GDP, 33% of its total funding comes from household «out of pocket expense», which indicates that change is necessary. Problems in the responsiveness of the health system to greater funding and public expenditure, linked to issues of rectorship and service organization, are apparent.Although there has been an increase in numbers of people with insurance, the restrictions on what is covered prevent the great majority of these people accessing health services. The most important change in the public administration of expenditure has been decentralization, while in the private administration it has been the vertical integration of providers and insurers, which has given rise to a new agent: the health investor.The article concludes that the country is still far from being able to finance the aim of universal access to health care. Recommendations to improve the funding, joint administration, and expenditure point, almost simultaneously, towards generating greater public funding and social security within an active policy aimed at improving the global efficiency and institutionality ofthe system, which should work to the advantage of better health results as well to drastically decrease household pocket expense. Therefore, the success of the financial function is closely related to the adequate performance of the functions of rectorship and provision. / El artículo tiene como objetivo ofrecer a los responsables de la rectoría en salud las reflexiones de política sectorial que se derivan del estudio de las Cuentas Nacionales de Salud (1995-2014) del país. Si bien el país ha incrementado el gasto en salud del 4,4 al 5,2% del PIB, el «gasto de bolsillo de los hogares» constituye el 33% del total del financiamiento, lo que requiere modificar sucomposición. Se advierten problemas en la capacidad de respuesta del sistema de salud al mayor financiamiento y gasto público, que se vinculan a temas de rectoría y organización de la prestación.Si bien el aseguramiento se ha incrementado, las restricciones en la oferta impiden que las personas afiliadas a algún tipo de seguro puedan, en su gran mayoría, acceder a los servicios de salud. El cambio más importante en la gestión pública del gasto es la descentralización, mientras que en la gestión privada lo es la integración vertical de prestadores y aseguradoras, dando surgimiento a un agente nuevo: el inversionista en salud.Se concluye que el país se encuentra, todavía lejos de poder financiar la meta de universalización del acceso en salud. Las recomendaciones para mejorar el financiamiento, mancomunación y el gasto apuntan, casi simultáneamente, a generar un mayor financiamiento público y de la seguridad social dentro de una activa política de mejora de la eficiencia global e institucional del sistema, la que debe redundar tanto en mejores resultados sanitarios, como en la disminución drástica del gasto de bolsillo. Por tanto, el buen éxito de la función financiera está íntimamente relacionado con el buen desempeño de las funciones de rectoría y prestación.

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2016-10-18T22:00:57Z No. of bitstreams: 1 DISSERTA??O ANDREI SOUZA TELES.pdf: 1414050 bytes, checksum: 2b5b002664ea70e3c434943166993948 (MD5) / Made available in DSpace on 2016-10-18T22:00:57Z (GMT). No. of bitstreams: 1 DISSERTA??O ANDREI SOUZA TELES.pdf: 1414050 bytes, checksum: 2b5b002664ea70e3c434943166993948 (MD5) Previous issue date: 2015-03-13 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / The health care financing consists of a structural and structuring element that underpins economic social practices that take care of human life. Considering the importance of funding the conduct, implementation and success of health policies, this work aimed to analyze the Public Expenditure of the Unified National Health System (SUS) in the state of Bahia, from 2009 to 2012. It is a quantitative study of a descriptive and analytical perspective, comparative and retrospective, covering all 417 municipalities in Bahia. The main data on funding for the health sector were declared by municipalities to Information System Public Health Budgets (SIOPS), collected between 2013 and 2014, and tabulated with the help of the National Health Accounts model (National Health Accounts - NHA), specifically using the Table 1 (Funding Sources for Finance Professionals), which was adapted to the reality of funding and Brazilian information systems. The results revealed that in Bahia public spending on the SUS, accumulated over four years of study, was about R$ 29,23 billion, 30% of which (8,66 billion) for the year 2012. In considering only the resources declared by municipalities to SIOPS, expended by the three spheres of government, there was an increase of 50,58% in the Public Expenditure on Health (GPS), totaling in the period from R$ 17,105 billion. The macro-East draws attention to the large volume of spending, surpassing the mark of R$ 1 billion every year, and two of its health regions, Salvador and Cama?ari, have been in the GPS ranking apex in the period. The health expenditure by size analysis showed that the vast majority of municipalities, about 70% did not reach the level of R$ 5 million. It was found in 2010 that 20% of resources, about R$ 410,30 million, were transferred to the 219 municipalities with the lowest Municipal Human Development Index (IDHM) the state, on the other hand, the 37 cities with the best IDHM received approximately 60% of federal funds, that is, more than R$ 1,23 billion. It was evident also that 30% of resources, approximately R$ 615,45 million, was allocated to 40% of the population, which is spread over 348 municipalities of the total of 417 present in Bahia and 50%, equivalent to more than R$ 1 billion, were also transferred to 40% of the population, but that is distributed in only 17 municipalities. With regard to the volume of federal funds specifically for the Mobile Emergency Service (SAMU), from 2009 to 2012, noted an increase of 148,31%, highlighting the East macro-region. However, half of the state health regions did not show whether spending records with this service. The relative share of SAMU as Average funding block component and high complexity grew in the period, reached 6,67% in 2012. Data analysis identified the existing inequalities in the distribution of resources among regions, health regions and municipalities in the state of Bahia, but also inequalities, as municipalities and regions were favored already privileged socioeconomic at the expense of locations where populations are greater risks of illness and death, which remained being contemplated with proportionally fewer resources in relation to their health needs. It is not intended to generalize these results, but it is expected this study to contribute in the formulation of health policy, planning and management of resources within the SUS. / O financiamento da aten??o ? sa?de consiste em um elemento estrutural e estruturante que alicer?a economicamente as pr?ticas sociais que cuidam da vida humana. Considerando a import?ncia do financiamento na condu??o, na execu??o e no ?xito das pol?ticas de sa?de, esta disserta??o teve como objetivo analisar o Gasto P?blico do Sistema ?nico de Sa?de (SUS) no estado da Bahia, no per?odo de 2009 a 2012. Trata-se de um estudo quantitativo do tipo descritivo-anal?tico, comparativo e retrospectivo, que abrangeu todos os 417 munic?pios baianos. Os principais dados acerca dos recursos financeiros destinados ao setor sa?de foram declarados pelos munic?pios ao Sistema de Informa??es sobre Or?amentos P?blicos em Sa?de (SIOPS), coletados entre 2013 e 2014, e tabulados com o aux?lio do modelo de Contas Nacionais de Sa?de (National Health Accounts ? NHA), especificamente com uso a Tabela 1 (Fontes de Financiamento por Agentes de Financiamento), que foi adaptada ? realidade do financiamento e dos sistemas de informa??o brasileiros. Os resultados revelaram que na Bahia o gasto p?blico com o SUS, acumulado nos quatro anos de estudo, foi de cerca de R$ 29,23 bilh?es, sendo 30% deste total (8,66 bilh?es) referentes ao ano de 2012. Ao considerar apenas os recursos declarados pelos munic?pios ao SIOPS, dispendidos pelas tr?s esferas de governo, verificou-se um crescimento de 50,58% no Gasto P?blico em Sa?de (GPS), totalizando no quadri?nio R$ 17,105 bilh?es. A macrorregi?o Leste chama aten??o pelo grande volume de gasto, ultrapassando a cifra de R$ 1 bilh?o em todos os anos, sendo que duas de suas regi?es de sa?de, Salvador e Cama?ari, estiveram no ?pice do ranking de GPS, no per?odo. A an?lise por porte de gasto em sa?de mostrou que a grande maioria dos munic?pios, cerca de 70%, n?o alcan?ou o patamar dos R$ 5 milh?es. Constatou-se, em 2010, que 20% dos recursos, cerca de R$ 410,30 milh?es, foram transferidos para os 219 munic?pios com os menores ?ndices de Desenvolvimento Humano Municipal (IDHM) do estado; por outro lado, os 37 munic?pios com os melhores IDHM, receberam, aproximadamente, 60% dos recursos federais, isto ?, mais de R$ 1,23 bilh?es. Evidenciou-se tamb?m que 30% dos recursos, em torno de R$ 615,45 milh?es, foi destinado a 40% da popula??o, que se encontra espalhada por 348 munic?pios do total de 417 presentes na Bahia e 50%, o equivalente a mais de R$ 1 bilh?o, foram transferidos tamb?m para 40% da popula??o, mas que se distribui por apenas 17 munic?pios. No que concerne ao volume de recursos federais destinados especificamente para o Servi?o de Atendimento M?vel de Urg?ncia (SAMU), de 2009 a 2012, notou-se um aumento de 148,31%, com destaque para a macrorregi?o Leste. Todavia, metade das regi?es de sa?de do estado n?o apresentou sequer registros de gasto com esse servi?o. A participa??o relativa do SAMU como componente do bloco de financiamento de M?dia e Alta Complexidade cresceu no per?odo, atingido 6,67%, em 2012. A an?lise dos dados permitiu identificar desigualdades existentes na distribui??o dos recursos entre macrorregi?es, regi?es de sa?de e munic?pios do estado da Bahia, e tamb?m iniquidades, uma vez que foram favorecidos os munic?pios e regi?es privilegiados socioeconomicamente, em detrimento das localidades onde as popula??es encontram maiores riscos de adoecer e morrer, as quais permaneceram sendo contempladas com recursos proporcionalmente menores em rela??o ?s suas necessidades de sa?de. N?o se pretende generalizar esses resultados, mas se espera com este estudo poder contribuir nos processos de formula??o da pol?tica de sa?de e de planejamento e gest?o dos recursos no ?mbito do SUS.

Made available in DSpace on 2015-07-15T13:31:40Z (GMT). No. of bitstreams: 1 UEFS - Dissertacao - Marcia Rosa.pdf: 1933540 bytes, checksum: db8809df1eeadbe0a91103b9d7008417 (MD5) Previous issue date: 2008-03-17 / The object of this paper was the process of financial management that to be in focus on the flow of financial resources since the origin as far as the immediate results of health activities. The objective, here, was to analyze municipal management of financial resources of Unified National Health System (SUS). This paper is a single study case that obtained in the documental analyses the evidence sources. The date financial were collected and analyzed through of the four table s proposal by National Health Accounts (NHA) and compared with the documental date. The characteristics of the service provider and of the activities were detailed carefully because of the methodology powerful with high the date separation. The result of research showed profile of date municipal resource: the federal government contributed to 82% of incomes, after municipality contributed to 17%, and, less participation the state that contributed to 1% of incomes. To point the Total Income of R$ 608,5 per capita and the pantry per capita of the 16 unities of the PSF (Family Health Program) vary from R$ 465,4 to R$ 62,3 per capita/unity/year. The Public Pantry with Health (GPS) per capita was R$ 261/hab/year. The PIB per cent that corresponded GPS was 4,4%. The proportion of incomes allocated to the hospitals was 47%, and ambulatory unities 44% showing a different profile of the another municipalities studied. The activities carried by Family Health Program Unities in 2005 were predominant Actions executed by nurse profession (38%); Actions basic medicines (28%) and Actions basic dentist (19%). Conclusion: a low capacity of collection taxes in 2005 year and co-financial insufficient of State. About health financial management of municipal system realized a planning process occurring in parallel; little coincide of LOA and PMS aims; a mask budget execution. The health responsibilities were carried partial proper sub-financial of three government sphere and the financing the federal government totally linked, taking the municipally co-finance what was prioritized by Union, and however, do not remain self municipal incomes to invest in local priorities. / O objeto deste estudo ? o processo de gest?o financeira focado no fluxo dos recursos desde a sua origem at? os resultados mais imediatos, as atividades de sa?de. O objetivo, aqui, ? analisar a gest?o municipal dos recursos financeiros do Sistema ?nico de Sa?de. Trata-se de um estudo de caso ?nico, que teve na an?lise documental a principal fonte de evid?ncias. Os dados financeiros foram coletados e analisados atrav?s de quatro tabelas propostas pelo National Helth Acounts (NHA) e comparados com as fontes documentais. As caracter?sticas dos provedores de servi?os e das atividades foram detalhadas ami?de devido ? potencializa??o da metodologia com a elevada desagrega??o dos dados. O resultado da pesquisa mostrou o perfil das fontes de recursos municipais: o governo federal contribuiu com 82% das receitas, seguido do munic?pio (17%) e, com a menor participa??o, o Estado (1%). Destaca-se a Receita Total de R$ 608,5 per capita; e os gastos per capita das 16 unidades do PSF variaram de R$ 465,4 a R$ 62,3 per capita/unidade/ano. O Gasto P?blico com Sa?de (GPS) per capita foi R$ 261/hab./ano. O porcentual do PIB que correspondeu ao GPS foi 4,4%. A propor??o de recursos alocados para os hospitais foi 47% e para as unidades ambulatoriais 44%, revelando um perfil diferenciado de outros munic?pios j? estudados. As atividades realizadas pelas Unidades de Sa?de da Fam?lia em 2005 foram redominantemente A??es executadas por profissionais de enfermagem (38%); A??es m?dicas b?sicas (28%) e A??es b?sicas em odontologia (19%). Concluiu-se que houve uma baixa capacidade de arrecada??o de impostos no ano de 2005 e um co-financiamento irris?rio do estado. Sobre a gest?o financeira da sa?de do sistema municipal percebeu-se: processos de planejamento ocorrendo paralelamente; pouca coincid?ncia dos objetivos da LOA e PMS; e um mascaramento da execu??o or?ament?ria. As responsabilidades sanit?rias foram parcialmente cumpridas devido ao sub-financiamento das tr?s esferas de governo e ao financiamento do governo federal totalmente vinculado, levando ao munic?pio co-financiar o que foi priorizado pela Uni?o e, por conseguinte, n?o sobrou recursos pr?prios para investir nas prioridades locais.