Financiamento do componente básico da assistência farmacêutica dos municípios brasileiros a luz do SIOPS.

Abstract

Introduction: Financing for pharmaceutical assistance has been the subject of studies in its various dimensions. The Basic Component of Pharmaceutical Assistance (CBAF) is the part responsible for access to essential medicines in the SUS, and its financing involves the federal government, states and municipalities. In this context, the Information System on Public Health Budgets (SIOPS) is of fundamental importance in recording and consolidating SUS financial information. In addition, the period of financial constraint experienced in Brazil in 2014 affected several social sectors and the responsiveness of public health services. Thus, it is understood that it is pertinent to verify the municipal financial records for the CBAF in SIOPS, the evolution of its funding and whether the economic crisis was reflected in this funding at the municipal level. With this, to meet this purpose, three articles were carried out. Article 1: Objective: to verify the consistency of information filling in the SIOPS by Brazilian municipalities, referring to the CBAF. Method: Descriptive study on the consistency of CBAF financial records in SIOPS, using Brazilian municipalities as the unit of analysis, from 2007 to 2017. In addition to SIOPS data, data from the National Health Fund and population data from IBGE were used. The proportions of municipalities declaring to SIOPS for income and expenses paid by CBAF were calculated and a descriptive statistical analysis was performed for the three entities of the Federation. Results: Between 2007 and 2017, there was an increase in the number of municipalities that declared revenues transferred by the federal government, from 43.26% in 2007 to 75.15% in 2017. As for expenses paid, the percentage of municipalities that declared to SIOPS increased considerably, from 8.73% in 2007 to 63.57% in 2017. The proportion of municipalities with financial records of state and own revenues in SIOPS for CBAF is still low, but there has been growth year on year, especially for the registration of municipal revenues. Article 2: Objective: To analyze the financial evolution of Brazilian municipalities for the CBAF, based on the SIOPS. Method: Descriptive and retrospective study in which data on CBAF revenues and expenses were analyzed, at the municipal level, from SIOPS, from 2008 to 2017. Financial data from SIOPS and Siga Brasil, the nature of the expenditure used in both systems was the paid execution phase. Municipalities that declared revenue and expenditure data for the CBAF other than zero over the period were selected in SIOPS. Population data from the IBGE were used and the financial values were deflated by the IPCA. Results: Siga Brasil data, related to all federal government expenditures with CBAF in municipalities, remained practically constant until 2014, falling in 2017. Fund transfers had a greater participation, while direct applications from the Ministry of Health to the CBAF were smaller. The Popular Pharmacy Program had a significant evolution, increasing about 386% between 2008-2017. The other financing sources increased their share in relation to total revenues and in relation to expenditures. Aggregate municipal expenditures for the CBAF in SIOPS increased through 2012, falling by 9.13% compared to 2017. Municipalities' per capita expenditures for the CBAF increased by an average of 29.84%, while federal fund-to-fund transfers decreased by 16. 75%. Per capita transfers from the federal government to municipalities have always been above the minimum established in the legislation, except in 2015 and 2017, while other sources of funding have surpassed the minimum counterparts since 2009. Article 3: Objective: To understand the impact of the 2014 economic crisis on the financing of the Basic Component of Pharmaceutical Assistance in the SUS at the municipal level. Method: This is a retrospective, descriptive study, with a quantitative approach, from 2009 to 2017, with municipalities as the unit of analysis. Municipalities were selected that declared to SIOPS their revenue information transferred by the federal government, by the state, their own revenues and their expenses, to the CBAF. Population data from the IBGE were used, and the average annual variation per capita was calculated considering two periods, pre-crisis (2009-2014) and after the crisis (2014-2017). Results: During the crisis, the average annual variation in per capita income and expenditure decreases in relation to the pre-crisis period. Per capita municipal revenue transferred by the federal government had an average annual variation of 0.44% in the pre-crisis period, but dropped to -2.95% in the crisis period. The share transferred by the states also dropped from -3.97% to - 9.09% after the crisis. Municipalities' own revenues showed a downward trend with an average annual variation of -1.78% during the crisis period. The per capita expenditure of municipalities for the CBAF showed a downward trend of -3.85% since the economic crisis. Regarding federal revenues transferred to municipalities, all regions had a negative average evolution during the crisis, with emphasis on the Southeast and Northeast. Conclusions: The three articles contribute to the understanding in the pharmaceutical field that the unicipalities did not comply, in part, with the regulations regarding the registration of data to the CBAF in the SIOPS, either due to errors or lack of knowledge of the system. Furthermore, CBAF funding over the lifetime of a specific funding mechanism has evolved positively and the municipalities themselves have contributed significantly to funding this component of pharmaceutical assistance. And, that the financing of the CBAF had repercussions of the economic crisis of 2014, both for the revenues made available to the municipalities by the three entities of the Federation, and in their expenses.