Total expenditure of the municipalities on primary healthcare in Brazil: a method to adjust the declared expenditure from 2015 to 2020

Recently, interest on the expenditure on primary healthcare (PHC) has grown due to a series of reforms to its organization and funding. Data on these and other expenses are declared via subfunctions by public health managers through the Brazilian Information System for the Public Budgets in Health (SIOPS). In the public budget, subfunctions detail in which expenditure area the government action was carried out. However, there are problems in the information via subfunctions, and the expenditures in main object areas - such as PHC - are commonly underestimated, if only the records of the specific subfunction are considered. Thus, this article proposes a method to adjust the total expenditure in primary care of each municipality, from 2015 to 2020, allowing for the production of adjusted databases to be used in PHC finance studies in Brazil. Therefore, an investigation based on budgetary-financial execution data in public health actions and services was conducted to produce a methodological framework, observing the following steps: (i) data identification; (ii) development; and (iii) validation of the methodological framework. The methodological framework was created and tested, confirming the validity of the proposed method for adjusting the expenditure declared for PHC in the period from 2015 to 2020. If the adjustment had not been made, the PHC expenditure would have been underestimated by BRL 11.4 billion, in 2015, and BRL 9.6 billion, in 2020, (at current prices), corresponding to a 19.8% and 12.6% underestimation, respectively.

Keywords:
Health Care Rationing; Health Expenditures; Budgets; Primary Health Care; Unified Health System