Analysis of public spending on health care in the Brazilian state capitals, 2000-2007

Introduction: The Brazilian Health System (SUS), created in 1988, established health care as a universal right and a State duty. The organization of the State comprises of the Federal Government, the States, the Federal District and Municipalities. Health care services and its funding fall under the mutual responsibility of these federate bodies. In 2000, with a view to attaining sustainability of the SUS, Constitutional Amendment 29 was established to govern its funding. Objective: To analyze the development and characteristics of public spending on health in the Brazilian state capitals. Methodology: The 26 Brazilian capitals were studied, making up the five regions of the country (Central-West, North, North-East, South and South-East). The data were gathered from the Information System for Health Care Public Budgets (SIOPS), focusing on the magnitude and evolution of health costs accountable to the municipal governments. Results: Overall health costs rose by 148% in the period, especially in the North-East (212%) and North (185%). Expenditure with exclusively municipal funds rose by 256% while funds allocated from the Federal and State governments rose by only 97% in the period. The percentage of the budget of the capital cities spent on health care grew from 11.7%, in 2000, to 18.3%, in 2007. Expenses with human resources increased in an unequal manner amongst the regions, which would call for more detailed investigations given that in numerous capitals such costs were greater than the exclusively municipal expenses. Conclusions: Health care costs increased in the capital cities and there is evidence of reduced inequality between the regions.  However, the capitals display certain characteristics (density, population heterogeneity and flow, technological concentration, service complexity, greater social control) which differ from capital to capital and in relation to other Brazilian towns. Therefore there is a need to investigate them separately and in a more detailed manner.