In the 1970s, Brazil had experienced a major change at public health sector, which summit can be translated into the current Unique Health System, SUS, the brazilian universal health system. In that period the public health... [ view full abstract ]
In the 1970s, Brazil had experienced a major change at public health sector, which summit can be translated into the current Unique Health System, SUS, the brazilian universal health system.
In that period the public health was divided in two ministries, Health (Ministry of Health, MS), more focused on health surveillance field, and the Social Security (Ministry of Welfare and Social Assistance, MPAS), controller of the general health care services.
In terms of financial volume, most of the spending resources was located in MPAS folder: about 80% of the funds in that period were aimed directly at Social Security, while the remaining funds were directed residually with MS. Therefore, the transfers for health sector were highly dependent on Social Security and Social Assistance Fund (FPAS), the financial arm of the MPAS, controlled by the federal government.
With the enactment of the Federal Constitution in 1988, SUS was formally established, unifying the health surveillance and health care. Still, the funding for the health sector stayed attached FPAS. With this, the legal delineation for the health financing system was reset, trying to define at the same time a direct source for funding (without dependence on MPAS) and the decentralization of federal actions in the basic services for the public health system.
Effectively, the decentralization process in health sector started within the laws 8.080 / 1990 and 8.142 / 1990 (also called Organic Health Laws), which assigned powers and responsibilities for the different levels of government, defining percentages to be directed transferred from the Social Security Budget to the health funds specifically.
Within respect to the autonomy for states and municipalities, coordination of different levels of the executive branch, problems of microeconomic policy, among others, were postponed with different norms during the 90´s and 00´s.
This study aims to problematize this norms in a detailed way. Despite some good improvements introduced for the universal health care, some externalities came along with the excess of regulations, with different metrics and goals difficulting the accountability and also brought some efficiency problems.
