[Connections between fiscal federalism and the funding of the Brazilian health care policy].
In the Brazilian society's context of meager financial resources for health care, associated with structural features of fiscal federalism and with the current model of funding transfers for the Unified Health System's (SUS), important inequities directly impact political negotiations and the deployment of federal financing alternatives which are not directly linked to the supply and production of health care activities and services by states and municipalities. We observed that health policies, since the second half of the nineties, have developed their own mechanisms that, in the above mentioned context, tend to accommodate different interests and federative conflicts generated by structural factors and by institutional rules. However, the absence of an integrated planning program between the criteria to establish resource redistribution for financing the Unified Health System and the Brazilian Federation's fiscal sharing system, end up reinforcing certain asymmetric patterns and generating new imbalances, making the compensation of inequities difficult in public health spending at the sub-national domain.
Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Manguinhos, 21041-210 Rio de Janeiro RJ. luciana@ensp.fiocruz.br
Luciana Dias
LD
de Lima
D001938:Brazil; D003695:Delivery of Health Care / Q000191:economics*; D005380:Financing, Government; D006291:Health Policy / Q000191:economics*