Luciana Teixeira

Sustentabilidade da política de acesso a medicamentos anti-retrovirais no Brasil

OBJETIVO: Os gastos com a aquisicao de anti-retrovirais no Brasil tem suscitado debates sobre a sustentabilidade da politica de acesso universal a medicamentos para Aids, a despeito de seus evidentes beneficios. O objetivo do estudo foi analisar, no periodo de 1998 a 2005, a evolucao dos gastos do Ministerio da Saude do Brasil com a aquisicao de anti-retrovirais e seus determinantes, assim como a sustentabilidade desta politica a medio prazo (2006-2008). METODOS: O estudo da evolucao dos gastos com anti-retrovirais compreendeu a analise de seus precos, do dispendio ano a ano, do numero de pacientes que utilizam a medicacao, do gasto medio por paciente e das estrategias para a reducao de precos adotadas no periodo. No tocante a analise de sustentabilidade da politica de acesso a anti-retrovirais foram estimadas as despesas com a aquisicao de medicamentos no periodo de 2006 e 2008 e a participacao desses gastos no Produto Interno Bruto e nas despesas federais com saude. Os dados foram coletados do Ministerio da Saude, do Instituto Brasileiro de Geografia e Estatistica e do Ministerio do Planejamento. RESULTADOS: As despesas com anti-retrovirais aumentaram 66% em 2005, interrompendo a tendencia de reducao observada no periodo 2000-2004. Os principais fatores associados a esse aumento foram o enfraquecimento da industria nacional de genericos e os resultados insatisfatorios dos processos de negociacao com empresas farmaceuticas. CONCLUSOES: A politica de acesso universal no Brasil nao e sustentavel com as atuais taxas de crescimento do Produto Interno Bruto, sem que o Pais comprometa investimentos em outras areas.

Consórcios intermunicipais de saúde: uma análise à luz da teoria dos jogos

The present article studies a new organizational structure in which neighboring health districts in Brazil form a partnership to jointly supply costly specialized health care services. Each district partially funds the organization. Depending on the partnership contract, a free rider problem arises. A district has the incentive to withdraw from the partnership if it can still benefit from its services, especially when political pressures for competing expenditures arise. The main conclusion is that the partnership sustainability is strongly influenced by the punishment mechanisms to a defaulting member, the gains from joint provision of health services and the overall economic environment.

Avaliação das metas de recursos previstos na declaração sobre HIV/Aids das Nações Unidas

This study evaluates the targets of the United Nations Declaration on HIV/AIDS Resource Targets, the attainment of which are premised on promoting three fronts: reduction of material and services costs, increased efficiency in access to and management of funds, and the channeling of new funds. Data were derived from studies of National Accounts of HIV/AIDS in Latin America and the Caribbean and from the recent available literature on the global dynamics of HIV/AIDS resources. The economic concept of global public good occurs throughout the text. The article discusses factors that constrain funding, and thus compel the adoption of new strategies in Brazil. The issues addressed include: difficulties in maintaining the downward tendency in the cost of items related to the HIV/AIDS epidemic, the incorporation each year of thousands of persons needing antiviral therapy, the rise in patient survival and increased diagnosis for the control of HIV/AIDS transmission. It is concluded that, in order to guarantee additional resources to combat the epidemic, the discussion on funding must necessarily focus on both the share of AIDS support for the Brazilian Ministry of Health, and, more importantly, on an increase in health funding as a whole. The recognition that HIV/AIDS control contributes to the global public good should facilitate increases in development assistance from international funding sources.