title: Federalism and decentralization: impact on international and Brazilian health policies.
abstract: This article discusses the implications of decentralization in the light of international and Brazilian federalism, and its effects on public health policy. In a comparative analysis among countries, the authors find there is no single model; rather, each country has a unique structure of institutions and norms that have important implications for the operation of its health system. Brazil shares some similarities with other countries that have adopted a decentralized system and is assuming features ever closer to U.S. federalism, with a complex web of relationships. The degree of inequality among Brazilian municipalities and states, along with the budgetary imbalances caused by the minimal levels of resource utilization, undermines Brazil's constitutional principles and, consequently, its federalism. To ensure the constitutional mandate in Brazil, it is essential, as in other countries, to create a stable source of funds and increase the volume and efficiency of spending. Also important are investing in the training of managers, improving information systems, strengthening the principles of autonomy and interdependence, and defining patterns of cooperation within the federation.
authors: Federal University of Rio Grande do Norte, Department of Economics, Natal, RN, Brazil. leite@ufrnet.br
authors: Valéria Rodrigues
authors: VR
authors: Leite
authors: Cipriano Maia
authors: CM
authors: de Vasconcelos
authors: Kenio Costa
authors: KC
authors: Lima
mesh_terms: D001938:Brazil; D005380:Financing, Government / Q000458:organization & administration / Q000639:trends; D014943:Global Health / Q000191:economics*; D006291:Health Policy / Q000191:economics*; D006801:Humans; D011056:Political Systems; D011057:Politics