Sérgio Francisco Piola

Os gastos das famílias com saúde

O artigo discute as principais caracteristicas dos gastos das familias brasileiras com saude, a partir de duas fontes distintas: a Pesquisa de Orcamentos Familiares (POF) e a Pesquisa Nacional por Amostra de Domicilios (PNAD). Mostra-se a importância do gasto com saude em relacao aos outros grupos de despesas, e se procede a estimativa do montante destes gastos. No artigo, apontam-se as duas principais categorias do gasto das familias com saude: os medicamentos e as mensalidades de planos ou seguros de saude. As familias das pessoas que estao entre os 30% mais ricos sao as responsaveis pela maior parte dos gastos totais. Nas familias das pessoas que pertencem aos 90% mais pobres da populacao, a maior parte dos dispendios com saude se dirige a compra de medicamentos. Quanto mais pobres sao as familias consideradas, maior e o peso, entendido como porcentagem da renda familiar, representado pelos gastos com medicamentos, planos e com saude em geral.

Descentralização e alocação de recursos no âmbito do Sistema Único de Saúde (SUS)

Este artigo trata da descentralizacao do SUS, particularmente no que se refere a distribuicao e ao processo de alocacao de recursos para a saude, nas tres esferas de governo. Assim, apresenta, por um lado, o marco constitucional e legal desse processo e analisa as Normas Operacionais que vem orientando o processo de descentralizacao no SUS. Por outro lado, aborda a regionalizacao da alocacao de recursos efetivamente executada pelo Ministerio da Saude, incluindo tanto os gastos diretos como os repasses para estados e municipios. Finalmente, sao feitas algumas consideracoes de ordem geral.

Necessidade de saúde insatisfeita no Brasil: uma investigação sobre a não procura de atendimento

Herein, unmet health care needs, defined by the authors as the situation when an individual feels the need but does not seek healthcare, are studied from the data of the health questionnaires of the 1998, 2003 and 2008 rounds of the National Household Sampling Survey (Pnad). From 1998 to 2008, the percentage of the population with healthcare needs during the two weeks prior to the interview did not change, remaining at around 17%, whilst the share with unmet healthcare needs fell from 3.5% to 2.9%. There were also changes in the reasons chosen by the interviewees to justify why they did not seek healthcare. The percentage of those who said they could not afford it decreased though it is still the reason given most frequently thereby boosting the percentages of those alleging problems with the healthcare system, such as long waiting times and a lack of professionals and services. People with less income or schooling, residing in the poorer regions of the country or in rural areas, blacks, males, adults, workers, people living with other people with unmet healthcare needs or that have not been to an appointment with a doctor in the last year, and those without health plans, are less likely to seek healthcare and therefore stand a higher chance of having unmet healthcare needs.

The effects of Constitutional Amendment 29 on the regional allocation of public funds for the National Health Service in Brazil.

This article analyzes the effects of Constitutional Amendment 29 in financing the Brazilian National Health Service, SUS, between 2000 and 2010. The aim was to analyze how the resources that were allocated by the three spheres of government were used on a general basis and in specific regions. Analysis was also conducted on the possible repercussions of the Amendment in the allocation of finances for SUS. The results showed: an important increase in the designated resources that were used by the three spheres of government during the aforementioned period. There was an increase in real terms of 112% in consolidated spending and an 89% increase in spending per capita by the three spheres. There was also more participation from the States, the Federal District and the Municipalities in financing the system. However, in spite of the increase in the use of financial resources, regional inequalities, in relation to spending per capita, remained practically unchanged.

Determinantes sociais, condicionantes e desempenho dos serviços de saúde em países da América Latina, Portugal e Espanha

Comparison can be an important resource for identifying trends or interventions that improve the quality of health services. Although Portugal and Spain have accumulated important knowledge in primary health care-PHC driven national systems, the Ibero-American countries have not been object of comparative studies. This paper presents an assessment using an analytical dashboard created by the Ibero-American Observatory on Policies and Health Systems. It discusses aspects that have stood out in monitoring the service systems of Argentina, Brazil, Colombia, Spain, Paraguay, Peru, and Portugal throughout the 21st centurys first decade. Forty-five indicators and time series showing the highest completeness degree divided into social determinants, conditions and performance were analyzed. Three trends are common to almost all countries: overweight increase, negative trade balance for pharmaceutical products, and an increase in health system expenditure. This convergence trend reveals the need for changes in the way of regulating, organizing and delivering health services with public policies and practices that guarantee comprehensive care, including health promotion actions enabling systems sustainability.