Effectiveness and financing of primary health care in Brazil

In Brazil, universal coverage, full services and management decentralization represent important guidelines of the Unified Health System, which is to be funded by all three governmental levels. Based on these guidelines, the study aims to analyze the effectiveness of the local health care systems as regards a full range of services and universal access to primary health care in a set of particular Brazilian towns, aiming to relate these factors to the level of local health care financing and spending.
Generating the indicator for effectiveness was achieved through the analysis of primary data collected by means of an evaluation survey conducted in towns and cities with over 100 thousand inhabitants in São Paulo, Brazil, and enabled the creation of three categories of towns and cities according to the level of effectiveness of the local health system: low effectiveness – incomplete services and no universal access; average effectiveness – either full services or universal access; high effectiveness – both full services and universal access. Meanwhile, the following indicators were used to measure the level of local health care financing and spending: the town’s tax capacity; total spending on health per inhabitant/year; percentage of local resources applied to health; and central funding as a percentage of total health care expenses.
The results lead to the conclusion that universal access and a full range of services is a condition that depend both on the amount of resources invested in health care by the local authorities and on the weight of central government funding in relation to total health care expenses, since towns which do not offer a complete range of services nor universal access present lower health care costs per inhabitant/year, lower percentages of local resources invested in health care and of central government funding as a proportion of total health spending.