Financial sustainability of the Brazilian Health System and health-related tax expenditures

Ocké-Reis, Carlos Octávio

doi:10.1590/1413-81232018236.05992018

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ARTICLE • Ciênc. saúde colet. 23 (6) • June 2018 • https://doi.org/10.1590/1413-81232018236.05992018 copy

Financial sustainability of the Brazilian Health System and health-related tax expenditures

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Using official data from Brazil’s Internal Revenue Service, this article estimates health-related federal tax expenditures between 2003 and 2015. The Ministry of Health will thus be able to assess the relevance of these subsidies within a context of gross underfunding of Brazil’s public health system. The analysis was built around concepts and theories developed in the fields of political economy and public finance, focusing on policies directed at public funding of the health sector. The results show that tax expenditures associated with health insurance plans was R$12.5 billion in 2015. It is suggested that these resources could be put to better use in public primary care and medium-complexity care services.

Health systems; Public health; Budgets; Government funding; Equity

Year	Health Expenditure (R$ million)		%
	Total	Health
2003	38,857	8,641	22.2
2004	49,8	10,515	21.1
2005	56,429	11,426	20.2
2006	81,24	14,894	18.3
2007	102,673	15,148	14.8
2008	114,755	17,05	14.9
2009	116,098	17,229	14.8
2010	135,861	18,376	13.5
2011	152,441	20,387	13.4
2012	181,747	23,431	12.9
2013	223,31	25,786	11.5
2014	257,223	29,019	11.3
2015	277,14	32,344	11.7

Year	Ministry of Health (R$ million)	Health-related Tax Expenditure (R$ million)	%
2003	27,181	8,641	31.8
2004	32,703	10,515	32.2
2005	37,146	11,426	30.8
2006	40,75	14,894	36.6
2007	44,304	15,148	34.2
2008	48,67	17,05	35.0
2009	58,27	17,229	29.6
2010	61,965	18,376	29.7
2011	72,332	20,387	28.2
2012	80,063	23,431	29.3
2013	83,053	25,786	31.0
2014	91,898	29,019	31.6
2015	100,055	32,344	32.3

(Values deflated based on National Consumer Price Index average 2015 prices) (Baseline 100 = 2003)
Year	GDP ¹ (R$ million)	Index	Ministry of Health ² (R$ million)	Index	Health-related Tax Expenditure (R$ million)	Index	Total Federal Spending on Health ³ (R$ million)	Index
2003	4,184,234	100	53,872	100	17,125	100	70,997	100
2004	4,425,245	106	60,805	113	19,551	114	80,355	113
2005	4,566,947	109	64,626	120	19,878	116	84,504	119
2006	4,747,889	113	68,049	126	24,872	145	92,921	131
2007	5,036,079	120	71,385	133	24,408	143	95,792	135
2008	5,292,627	126	74,206	138	25,995	152	100,201	141
2009	5,285,968	126	84,702	157	25,045	146	109,747	155
2010	5,683,908	136	85,753	159	25,431	148	111,183	157
2011	5,909,810	141	93,87	174	26,457	154	120,327	169
2012	6,023,348	144	98,576	183	28,849	168	127,425	179
2013	6,204,339	148	96,284	179	29,894	175	126,178	178
2014	6,235,606	149	100,196	186	31,64	185	131,836	186
2015	6,000,570	143	100,055	186	32,344	189	132,399	186

(Values deflated based on NCPI average prices 2015) (Baseline 100 = 2003)
Year	Corporation Tax (R$ million)	Index	Personal Tax (R$ million)	Index	Medications and Chemical Products (R$ million)	Index	Philanthropic Hospitals (R$ million)	Index	TOTAL (R$ million)	Index
2003	7,422	100	2,302	100	2,223	100	5,179	100	17,125	100
2004	8,476	114	2,434	106	2,746	124	5,895	114	19,551	114
2005	8,656	117	2,615	114	3,014	136	5,594	108	19,878	116
2006	9,645	130	2,874	125	6,61	297	5,743	111	24,872	145
2007	10,484	141	3,387	147	4,634	208	5,903	114	24,408	143
2008	11,468	155	3,326	144	4,714	212	6,488	125	25,995	152
2009	9,876	133	3,31	144	5,023	226	6,836	132	25,045	146
2010	9,429	127	3,676	160	5,001	225	7,325	141	25,431	148
2011	10,014	135	3,812	166	4,641	209	7,991	154	26,457	154
2012	10,788	145	4,118	179	5,156	232	8,787	170	28,849	168
2013	11,125	150	4,693	204	5,029	226	9,047	175	29,894	175
2014	11,678	157	4,717	205	5,489	247	9,756	188	31,64	185
2015	11,672	157	4,539	197	6,619	298	9,514	184	32,344	189

(Valores deflacionados pelo IPCA a preços médios de 2015) (Base 100 = 2003)
Year	Hospitals and Clinics Brazil (R$ million)	Index	Hospitals and Clinics Outside Brazil (R$ million)	Index	Health Plans (R$ million)	Index	Health Professionals Brazil (R$ million)	Index	Health Professionals Outside Brazil (R$ million)	Index	TOTAL (R$ million)	Index
2003	1,417	100	28	100	3,845	100	2,023	100	108	100	7,422	100
2004	1,618	114	32	114	4,392	114	2,31	114	124	114	8,476	114
2005	1,561	110	27	95	4,76	124	2,206	109	102	94	8,656	117
2006	1,761	124	27	96	5,398	140	2,362	117	98	90	9,645	130
2007	2,474	175	40	140	5,778	150	1,89	93	303	280	10,484	141
2008	2,771	196	45	160	6,57	171	1,901	94	180	167	11,468	155
2009	2,197	155	19	65	6,006	156	1,6	79	55	51	9,876	133
2010	1,824	129	14	49	5,976	155	1,601	79	14	13	9,429	127
2011	2,059	145	15	53	6,269	163	1,664	82	8	7	10,014	135
2012	1,988	140	15	53	7,107	185	1,663	82	6	6	10,78	145
2013	1,942	137	16	57	7,488	195	1,582	78	6	6	11,034	149
2014	2,005	142	14	48	8,002	208	1,562	77	6	5	11,589	156
2015	2,125	150	15	54	8,014	208	1,427	71	7	6	11,588	156

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[TFN1001] Elaborated by Department of Studies and Social Policies (Disoc)/Institute of Applied Economic Research (Ipea).