Crisis and federalism: trends and regional patterns of health revenues and expenditures in the brazilian states

Contarato, Priscilla Caran; Lima, Luciana Dias de; Leal, Rodrigo Mendes

doi:10.1590/1413-812320182412.25302019

Priscilla Caran Contarato

Escola Nacional de Saúde Pública Sérgio Arouca, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil. priscillacontarato@gmail.com

http://orcid.org/0000-0002-2518-012X

Luciana Dias de Lima

Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública Sérgio Arouca, Fiocruz. Rio de Janeiro RJ Brasil.

http://orcid.org/0000-0002-0640-8387

Rodrigo Mendes Leal

Banco Nacional de Desenvolvimento Econômico e Social (BNDES). Rio de Janeiro RJ Brasil.

http://orcid.org/0000-0002-9908-3381

Collaborations

PC Contarato was responsible for the design, development, collection, and preparation of the database, analysis of information, preparation of tables and figures, drafting and final review of the paper. LD Lima was responsible for the design, development, analysis of information, drafting, and final review of the paper. RM Leal was responsible for the design, analysis of information, preparation of tables, and final review of the paper.

Indicator	Definition	Interpretation	Calculation Method	Calculation formula	Data Source
1. Net Current Revenue (NCR) per Capita	Current revenue minus constitutional transfers and social contributions per inhabitant (in R$).	Indicates the budgetary resources available to the state for the execution of the expenses of the activities of the public administration entities.	Numerator: current revenue less total constitutional transfers and social contributions. Denominator: total resident population.	{1.0.00.00.00 - [(0,5* 1.1.12.05.00) + (0,25* 1.1.13.02.00) + (0,25* 1.7.21.01.12) + 9.1.1.12.05.00 + 9.1.1.12.07.00 + 9.1.1.13.02.00 + 9.1.7.21.01.01 + 9.1.7.21.01.12 + 9.1.7.21.09.01)] - 1.2.10.00.00}/ state population	FINBRA and IBGE
2. Percentage of directly collected revenues	Percentage of directly collected revenue against net current revenue (%).	Indicates the importance of directly raised funds (taxes, fees, contributions, fines, and default interest) as a source of budget revenue.	Numerator: total revenues from taxes, fees, contributions, and fines X 100. Denominator: NCR.	[1.1.12.04.00 + (0,51.1.12.05.00) + 1.1.12.07.00 + (0,751.1.13.02.00) + 1.1.20.00.00 + 1.1.30.00.00 + 1.2.2.0.00.00 + 1.6.00.00.00 + 1.9.11.00.00 + 1.9.13.00.00 + 1.9.31.00.00] / NCR * 100	FINBRA
3. Percentage of redistributive transfers	Percentage of federal redistributive transfers against net current revenue (%).	Indicates the relevance of federal redistributive transfers as a source of budget revenue; federal redistributive transfers aim to reduce inequalities in spending capacity between states.	Numerator: financial transfers from the FPE share X 100. Denominator: NCR.	1.7.21.01.01/ NCR*100	FINBRA
4. Percentage of compensatory transfers	Percentage of federal compensatory transfers against net current revenue (%).	Shows the relevance of federal compensatory transfers as a source of budget revenue; federal compensatory transfers are those intended to offset the loss of revenue arising from the ICMS export exemption.	Numerator: total financial transfers performed from ICMS + exemption Complementary Law No. 87/96 (Kandir Law) + 75% of IPI Export X 100. Denominator: NCR.	[1.7.21.36.00 + (0,75* 1.7.21.01.12)] /NCR*100.	FINBRA
5. Percentage of health-related revenues	Percentage of health-related revenues against net current revenues (%).	Shows the relevance of health-related resources as a source of budget revenue; health-related revenues are those directed to the exclusive financing of the health sector.	Numerator: total health-related revenues (transfers from the SUS; agreements; provision of services, among others) X 100. Denominator: NCR.	[(1.7.21.33.00) + (1.7.22.33.00) + (1.7.23.01.00) + (1.7.61.01.00) + (1.7.62.01.00) + (1.7.63.01.00) + (1.6.00.05.00)] /NCR*100.	FINBRA
6. Health expenditure per capita	Total public health expenditure per inhabitant (in R $).	This is the total public health expenditure, under state responsibility, from all sources.	Numerator: committed health expenditure from all sources (taxes, SUS transfers, credit operations, among others). Denominator: total resident population.	3.3.0.00.00.00.00 + 3.4.0.00.00.00.00 - 3.3.1.90.01.00.00 - 3.3.1.90.03.00.00	SIOPS and IBGE

Year	Brazil's Actual GDP Growth Rate (%)	Actual Total NCR Growth Rate of States (%)	North Region	Northeast Region	Midwest Region	Southeast Region	South Region
2006	4.0
2007	6.1	5.5	8.3	3.2	9.0	6.0	3.8
2008	5.1	12.8	16.1	12.4	15.1	12.2	12.7
2009	-0.1	-1.7	-2.7	0.2	-0.9	-3.0	0.4
2010	7.5	8.9	6.9	9.4	4.8	9.6	8.8
2011	4.0	5.3	12.6	5.7	10.2	3.7	4.0
2012	1.9	1.8	3.9	1.7	6.0	0.9	1.9
2013	3.0	4.3	1.6	9.7	-2.9	3.2	6.0
2014	0.5	2.8	4.0	-0.2	28.4	-1.5	10.2
2015	-3.5	-5.9	-6.7	-4.8	-18.7	-5.0	-2.8
2016	-3.3	-1.6	4.9	3.7	10.5	-7.2	-0.9
Mean(2006 to 2016)	2.0	3.1	4.7	4.0	5.5	1.7	4.3

Coefficient of Variation of the per capita NCR
Years	Coefficient of Variation of the per capita NCR of the states, by region and total						Inequality between regions
Years	N	NE	MW	SE	S	Total	Inequality between regions
2006	42%	23%	19%	21%	6%	42%	17%
2007	40%	21%	18%	19%	6%	44%	19%
2008	43%	21%	20%	18%	9%	46%	19%
2009	43%	20%	22%	17%	9%	45%	18%
2010	37%	20%	17%	16%	9%	38%	17%
2011	39%	19%	14%	17%	8%	42%	17%
2012	35%	16%	14%	17%	5%	39%	18%
2013	36%	15%	19%	15%	3%	38%	15%
2014	39%	17%	43%	14%	9%	43%	19%
2015	35%	17%	18%	11%	6%	36%	15%
2016	37%	13%	26%	9%	1%	39%	16%
Coefficient of Variation of the per capita Health Expenditure
Years	Coefficient of Variation of the per capita Health Expenditure of the states, by region and total						Inequality between regions
Years	N	NE	MW	SE	S	Total	Inequality between regions
2006	36%	45%	47%	64%	24%	61%	28%
2007	39%	50%	51%	68%	7%	62%	25%
2008	40%	42%	58%	68%	11%	62%	25%
2009	41%	41%	57%	67%	15%	60%	23%
2010	38%	38%	53%	69%	15%	56%	21%
2011	40%	42%	57%	69%	15%	61%	26%
2012	43%	46%	44%	69%	20%	64%	26%
2013	41%	24%	20%	70%	4%	59%	26%
2014	43%	23%	17%	36%	4%	51%	21%
2015	40%	21%	29%	35%	5%	49%	19%
2016	37%	17%	28%	34%	5%	48%	17%

[1] Collaborations

PC Contarato was responsible for the design, development, collection, and preparation of the database, analysis of information, preparation of tables and figures, drafting and final review of the paper. LD Lima was responsible for the design, development, analysis of information, drafting, and final review of the paper. RM Leal was responsible for the design, analysis of information, preparation of tables, and final review of the paper.

Brasil

Brasil

Crisis and federalism: trends and regional patterns of health revenues and expenditures in the brazilian states

Abstract