Health financing and primary health care models in Brazil

The study aims to analyze the relations between public health service funding in Brazilian municipalities and primary health care (PHC) models adopted in these towns and cities. Using a model of statistical factor analysis that accounted for 81% of the variability data regarding basic outpatient throughput, coverage and kind of procedures, the municipalities were classified in the following four groups of PHC models: 1) PHC model with services delivered by public units; 2) PHC with emphasis on family health strategy; 3) PHC with a large proportion of specialized procedures; and 4) PHC with a strong presence in the private sector and outpatient throughput characterized by procedures of medium to high complexity. Health care financing and spending indicators were obtained from Brazil Ministry of Health.
The results show that the group of towns which adopt PHC model with emphasis on family health strategy reports lower tax capacity, lower total health costs, a lower percentage of local resources applied to health and a higher percentage of federal funds. On the other hand, the towns which centre their primary health care services in public units report higher tax capacity, higher total health costs and a higher percentage of local resources invested in health care. Meanwhile, the group with a larger share of specialised procedures in outpatient throughput is noted for its above average tax capacity and less federal funding. Finally, the towns which adopt a diverse model report below average levels of both tax capacity and total health spending.
These results lead to the conclusion that the tax capacity of Brazilian towns tends to condition the PHC models they adopt; these models, meanwhile, imply different standards of local health care spending and financing, with high variations in relation to other health financing indicators.