Perfil de gasto público em saúde e sua Influência sobre a curva da mortalidade infantil: uma análise dos municípios baianos

Abstract

Given the persistence of high infant mortality rates in the state of Bahia, this study seeks to establish relationships between health spending and the infant mortality rate in the municipalities of Bahia. The objective is to identify the contribution of the municipal health spending profile to the reduction of child deaths from 2005 to 2016. It is an ecological study that uses the econometric model of panel data, with fixed effects. After applying the exclusion criteria, the sample consists of annual data from 167 municipalities observed over a 12-year data panel totaling 2,004 observations. The results showed an annual decreasing trend in infant mortality, although with different rhythm and speeds for its components. It was found that the rate of reduction of neonatal mortality was 71% slower than the post-neonatal mortality, which caused its participation in the total of infant deaths to reduce from 36 to 28% in the period studied. Health expenditures showed an increasing trend both in the total volume invested and in its per capita distribution. Although the growth of the three components of health spending (Total Expenditure, Basic Care Expenditure and Expenditure on Own Resources) was observed, total spending grew in a larger proportion than the other two, indicating that more resources are being transferred and are being invested in health at other levels of care. It is concluded that infant mortality followed a downward trajectory in the quadrennium analyzed, while health spending followed the opposite trajectory. The relationship between these two phenomena was estimated to be negative at -0.14 with significance at 1%. The results pointed to the influence of per capita basic care spending on family health coverage in the municipalities, the 0.372% increase in prenatal coverage, and a reduction in hospitalizations of children under one year of age for causes sensitive to basic care. It was also observed that in the municipalities where infant mortality was higher than the national average at the beginning of the study period and Family Health Program coverage was considered absent or incipient, the increase in per capita spending on basic care produced a greater effect than in other municipalities, being able to reduce by 0.46 deaths for each thousand live births each year. The limitations of this study are related to the quality of the available secondary data and the nonhierarchic among the variables in statistical modeling, opening possibilities for future studies that include this refinement. The conclusions presented in this study aim to contribute to the planning of public policies aimed at reducing child deaths in the state of Bahia that are effectively capable of minimizing the inequities of allocation, contributing to the reduction of inequalities and reaching the commitment to reduce preventable child deaths.