Spending constraint and unpaid commitments on the federal budget for the Brazilian public health system

Vieira, Fabiola Sulpino; Santos, Maria Angelica Borges dos

doi:10.1590/0034-7612162491

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Brasil

Revista de Administração Pública

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Forum: Practical Perspectives • Rev. Adm. Pública 52 (4) • Jul-Aug 2018 • https://doi.org/10.1590/0034-7612162491 copy

Spending constraint and unpaid commitments on the federal budget for the Brazilian public health system

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article explores the execution of the Brazilian federal budget for public health programs and services (ASPS), from 2002 to 2015, analyzing the impact of the spending constraint and unpaid commitments on the public healthcare system (SUS) financing. It was found that in this period the authorized payment limit for the Ministry of Health was insufficient to pay yearly expenses, engendering significant amounts of unpaid commitments. In addition, the cancellation of part of the unpaid commitments impacts the allocation of resources in ASPS, further aggravating SUS financing difficulties.

Keywords:
healthcare financing; unified health system; financing government; budgets; Brazil

Current BR reais
Fiscal year	Minimum mandatory health care (ASPS) allocation (A)	Authorised appropriation (B)	Committed expenditures in ASPS ( C)	Differences between authorized appropriations and committed expenditures (D)=(B)-(C)	Confirmed unpaid commitments (E)	Reference fiscal year of 2016 unpaid commitments (F)	Unpaid commitments cancelled up to December 2015 (G)	Actual allocations to health services and programs (H) = (C) - (G)	Allocation deficit or surplus relative to mandatory allocation (I) = (H) - (A)
2002	23,654,072,386	25,863,275,274	24,708,886,048	1,154,389,226	1,775,608,171	-	500,621,283	24,208,264,765	554,192,380
2003	27,775,574,922	27,862,427,795	27,012,053,580	850,374,215	1,988,250,476	15,210,023	191,385,917	26,820,667,663	-954,907,259
2004	31,368,169,963	33,946,102,413	32,505,074,531	1,441,027,882	2,835,359,333	27,742,489	709,684,457	31,795,390,074	427,220,111
2005	37,051,473,809	38,790,692,865	36,291,911,037	2,498,781,828	3,292,101,800	36,723,950	609,518,424	35,682,392,612	-1,369,081,196
2006	40,613,666,045	42,236,890,275	40,520,675,993	1,716,214,282	4,357,106,368	42,008,726	809,448,929	39,711,227,063	-902,438,981
2007	44,275,043,408	47,488,689,966	44,051,896,820	3,436,793,146	5,603,463,981	188,985,510	1,330,410,968	42,721,485,852	-1,553,557,555
2008	48,561,056,485	51,012,550,613	48,428,024,812	2,584,525,801	5,684,995,031	179,790,177	1,062,962,895	47,365,061,917	-1,195,994,568
2009	54,963,098,717	59,425,947,559	58,016,587,301	1,409,360,258	8,562,061,372	512,361,286	1,378,579,078	56,638,008,223	1,674,909,506
2010	61,230,118,407	64,097,993,244	61,655,883,258	2,442,109,986	6,256,801,120	371,551,174	945,703,271	60,710,179,987	-519,938,420
2011	72,128,481,132	74,307,027,814	71,986,348,320	2,320,679,494	8,411,506,344	842,141,407	928,733,013	71,057,615,307	-1,070,865,826
2012	79,512,720,487	88,807,286,534	79,720,365,348	9,086,921,186	8,530,343,582	1,127,156,083	659,200,419	79,061,164,928	-451,555,559
2013	82,911,207,594	90,161,494,440	83,053,255,549	7,108,238,891	7,642,873,364	1,071,932,777	386,814,320	82,666,441,229	-244,766,366
2014	91,616,046,694	97,932,046,073	92,243,191,171	5,688,854,902	7,136,587,185	2,216,549,138	235,994,424	92,007,196,747	391,150,053
2015	98,313,048,464	110,449,163,999	100,460,337,118	9,988,826,881	7,880,465,468	7,880,465,468	-	100,460,337,118	2,147,288,654
2016	-	109,020,795,238	-	-	-	-	-	-	-

Current BR reais
Fiscal year	Payment limit plus unpaid commitments (A)	Committed expenditures on ASPS under titles GND 3,4,and 5*	Unpaid commitments for ASPS under titles GND 3,4 and 5	Expenditures for fiscal year plus unpaid commitments for ASPS under titles GND 3,4 and 5	Paid commitments plus unpaid commitments for GND 3,4 and 5 (E)	Differences between expenditures for fiscal year plus sum of commitments payed and unpaid commitments (F) = (D) - (E)	Net result considering payment limits and total expenditures G) = (A) - (D)	Net result considering payment limits and commitments paid (H) = (A) - (E)
2002	22,020,079,000	21,734,961,450	2,012,332,130	23,747,293,580	21,641,881,165	2,105,412,414	-1,727,214,580	378,197,835
2003	24,037,787,600	23,676,395,615	1,962,834,126	25,639,229,741	22,998,574,696	2,640,655,045	-1,601,442,141	1,039,212,904
2004	30,266,942,000	28,695,034,233	2,065,031,605	30,760,065,837	27,579,439,253	3,180,626,585	-493,123,837	2,687,502,747
2005	33,267,273,000	33,004,362,446	3,064,373,564	36,068,736,011	31,684,584,920	4,384,151,090	-2,801,463,011	1,582,688,080
2006	35,733,750,406	35,800,293,804	4,028,433,436	39,828,727,239	33,753,470,588	6,075,256,651	-4,094,976,833	1,980,279,818
2007	37,958,009,000	39,275,114,343	5,881,811,106	45,156,925,449	37,219,812,986	7,937,112,463	-7,198,916,449	738,196,014
2008	44,449,736,000	42,756,447,360	7,537,308,863	50,293,756,222	40,327,976,976	9,965,779,246	-5,844,020,222	4,121,759,024
2009	47,876,506,000	51,322,711,566	9,601,734,891	60,924,446,457	46,852,345,487	14,072,100,970	-13,047,940,457	1,024,160,513
2010	52,189,615,000	54,129,788,691	13,177,267,418	67,307,056,109	54,323,458,605	12,983,597,503	-15,117,441,109	-2,133,843,605
2011	57,879,618,000	63,717,161,007	12,517,714,428	76,234,875,435	60,495,685,416	15,739,190,018	-18,355,257,435	-2,616,067,416
2012	68,327,412,000	71,200,300,603	13,970,080,582	85,170,381,186	69,130,382,154	16,039,999,032	-16,842,969,186	-802,970,154
2013	74,445,610,000	74,253,107,705	14,827,018,446	89,080,126,150	73,578,344,389	15,501,781,761	-14,634,516,150	867,265,611
2014	84,643,171,201	82,944,282,440	14,243,901,288	97,188,183,728	83,001,094,821	14,187,088,907	-12,545,012,527	1,642,076,380
2015	86,991,129,000	90,940,466,983	13,339,827,565	104,280,294,548	88,982,681,364	15,297,613,185	-17,289,165,548	-1,991,552,364

Fundação Getulio Vargas Fundaçãoo Getulio Vargas, Rua Jornalista Orlando Dantas, 30, CEP: 22231-010 / Rio de Janeiro-RJ Brasil, Tel.: +55 (21) 3083-2731 - Rio de Janeiro - RJ - Brazil
E-mail: rap@fgv.br

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[1] Fabiola Sulpino Vieira - Doctor in Public Health. Civil servant. Public policies and Government Management Specialist. Works in the Department of Social Policy Studies at IPEA (Institute for Applied Economic Research). E-mails: fabiola.vieira@ipea.gov.br and fabiolasulpino@uol.com.br.