Falling federal resources in the SUS overwhelms states and municipalities, say experts

Representatives of councils that bring together states and municipalities say that their expenses are overloaded due to the drop in the transfer of federal funds to the SUS (Unified Health System).

“With this drop, there was an increase in resources for the municipalities, because it is the mayors who are at the forefront and they are pressured to provide answers to medical care. Today, those who spend more on health are states and municipalities”, says Blenda Leite, advisor technique in health economics from Conasems (National Council of Municipal Health Departments).

The statement was made during the 9th edition of the All Together Against Cancer Congress, which began on Tuesday morning (27), in São Paulo, and ran until this Thursday (29).

The event brought together specialists from different areas of health, references in national and international oncology. The congress is organized by the Todos Juntos Contra o Câncer (All Together Against Cancer Movement), an entity that brings together more than 200 civil society organizations.

Data presented by Leite show that the Union was responsible for 44% of spending on the SUS in 2021, while states and municipalities together bore 56% of expenses.

The specialist says, however, that most of the resources should come from the federal government because its collection capacity is greater than that of other entities. “This resource has to come from those who collect the most.”

She points out that the money for investments in health has been cut, which further compromises the effectiveness of the system. “The scrapping of equipment will increase. If I don’t have the resources to acquire new equipment, there’s no way to improve the response capacity.”

Leite also says that public health spending in Brazil in 2019 represented 3.8% of GDP (Gross Domestic Product), while in the private sector this percentage reaches 5.8%.

“Public expenditure on health has never been greater than private expenditure, but we have 180 million people who depend on the SUS. Therefore, it is incoherent for a country of this size, which has a public health system, to spend less than health care toilet.”

René José Moreira dos Santos, coordinator of institutional development at Conass (National Council of Health Secretaries) has a similar opinion. He says it is important to increase public spending on the SUS, since countries that have a similar system usually spend up to 7% of GDP on health.

“We need to fight for federal resources to increase. Regardless of who wins the elections, we need to seek mechanisms for spending to reach 5% of GDP.”

The specialist says that the expansion is important to increase investments in primary care.

“It’s a big challenge to make a model that takes primary care into account, because we’re very hospital-centric,” he says, adding that this first level of care is important for diagnosis and disease prevention.

In a note, the Ministry of Health says that it regularly transfers resources to states and municipalities to finance health actions and services.

“In 2021, BRL 179.1 billion was allocated. In 2019, BRL 122.2 billion was allocated. The resources are intended for the cost of medium and high complexity actions, health surveillance, primary care, pharmaceutical assistance, maintenance of actions and public health services, among others”, says the folder.

Doctor Natan Katz works in primary care and says it is necessary to invest more in technology for early diagnosis, preventing the patient from having to wait for a specialist.

“And, in case we refer the patient to specialized care, it is important that the service does not take too long”, he says, emphasizing that this process needs to be fast so that the patient starts treatment as soon as possible, which increases the chances cure in the case of cancer.

René José, representative of Conass, says that the SUS managed to respond well to the pandemic even with these challenges. “Not any country in the world can suddenly open thousands of ICU beds. The SUS responded accordingly. Before the pandemic, who could have imagined that we would have so many people shouting ‘Viva o SUS?'”