A portrait of Brazilian primary care: municipal expenditure and infrastructure in Brazilian municipalities

Kashiwakura, Helder Kiyoshi; Gonçalves, Andréa de Oliveira; Azevedo, Ricardo Rocha de; Nunes, André; Silva, César Augusto Tibúrcio

doi:10.1590/1413-81232021269.2.37112019

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HEALTH POLICY, IMPLEMENTATION OF PRACTICES • Ciênc. saúde coletiva 26 (suppl 2) • 2021 • https://doi.org/10.1590/1413-81232021269.2.37112019 copy

A portrait of Brazilian primary care: municipal expenditure and infrastructure in Brazilian municipalities

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The paper presents the relationship between the allocation of financial resources and the type of local basic health infrastructure in an initial sample of 5,570 Brazilian municipalities. This is an explanatory research using multiple correspondence analysis and quantile regression between expenditure/control variables and the type of structure of PHC Units. The correspondence between the type and the representative variables of expenditure shows that inferior typologies are related to lower per capita expenditure in these variables, and vice versa. Quantile regression showed a positive relationship with the type of infrastructure in the two cycles evaluated. There is evidence that expenditure variables are positively related to infrastructure, which allows us to understand that allocating more resources leads to better infrastructure. Results point to the need to improve the governance of financial resources for health, as municipalities with lower socioeconomic indicators have an infrastructure in the lower categories. We can conclude that there are multiple actors, and the various criteria for allocating and decentralizing resources bring about difficulties of coordination and integration between the entities, restricting the appropriate prioritization in the distribution of resources.

Key words:
Primary health care; Health expenditures; Health infrastructure; Governance

Country		Per capita GDP in dollars, in GDPPC (2004)	Total per capita health expenditure, public and private, in GDPPC (2004)	Total health expenditure, public and private, as % of GDP (2004)	Probability of a child dying < 5 years / 1,000 live births (2005)
Argentina		12,530	1,274	9.6	16
Brazil		7,940	1,520	8.8	33
Chile		10,610	720	6.1	10
Costa Rica		9,220	592	6.6	12
Uruguay		9,030	784	8.2	15
Canada		30,760	3,173	9.8	6
United Kingdom		31,430	2,560	8.1	6
Country	Population, in housands (2016)	Per capita GDP, in dollars, in GDPPC (2017)	Total per capita health expenditure, public and private, in GDPPC (2014)	Total health expenditure, public and private, as % of GDP (2014)	Probability of a man/woman dying between 15 and 60 years/1,000 (2016)
Argentina	43,000	20,270	1,137	9.6	143/80
Brazil	207,000	15,160	1,318	8.3	194/91
Chile	17,000	23,670	1,749	7.8	114/60
Colombia	48,000	14,170	962	7.2	182/92
Costa Rica	4,857	16,100	1,389	9.3	126/66
Uruguay	3,444	21,870	1,792	8.26	149/79
Canada	36,000	46,070	4,641	10.4	76/49
United Kingdom	65,000	42,560	3,377	9.1	81/52
USA	322,000	60,200	9,403	17.1	142/86

Groups	Variable code	Variable content
Economic category	desp_pess_enc_cpt	Per capita staff expenditure
	odc_cpt	Per capita other current expenditure
	desp_cap_cpt	Per capita capital expenditure
	invest_cpt	Per capita investment
	desp_geral_cpt	Per capita general expenditure
Sub-function	liq_sub_adm_cpt	Per capita administrative sub-functions
	liq_sub_vinc_cpt	Per capita linked sub-functions
	liq_atbas_cpt	Per capita primary health care expenditure
	liq_desp_tot_cpt	Total per capita expenditure
Expenditure block	atbas_fed_cpt	Per capita federal primary health care expenditure
	atbas_est_cpt	Per capita state primary health care expenditure
	atbas_rprop_cpt	Per capita municipal primary health care expenditure
	atbas_tot_cpt	Total per capita primary health care expenditure
	tot_fed_cpt	Total per capita federal expenditure
	tot_est_cpt	Total per capita state expenditure
	tot_rprop_cpt	Total per capita municipal expenditure
	tot_tot_cpt	Total per capita expenditure

Trend of the Primary Health Care Unit type
Type	Score	Cycle 1		Cycle 2
Type	Score	Number of UBS	%	Number of UBS	%
1 - Failed 2 - Rudimentary 3 - Restricted 4 - Regular 5 - Benchmark	< 0.250 ≥ 0.250 and < 0.5 ≥ 0.5 and < 0.75 ≥ 0.75 and < 1.0 = 1.0	1,690 3,639 10,364 20,102 3,017	4.35 9.38 26.70 51.79 7.77	445 138 4,200 18,816 900	1.8 0.6 17.1 76.8 3.7
Total		38,812	100.0	24,499	100.0
Final score of PHC expenditure and type
State		PHC expenditure (per capita annual mean, in R$)		Final score (mean)
Pará		207		0.83
Roraima		219		0.66
Pernambuco		233		0.88
Paraná		571		0.85
São Paulo		722		0.84

Impact of expenditure variables on the type									Impact of control variables on the type
Group	Variable	2012			2014			Variable meaning	Variable	2012			2014
Group	Variable	Q0.10	Q0.50	Q0.95	Q0.10	Q0.50	Q0.95			Q0.10	Q0.50	Q0.95	Q0.10	Q0.50	Q0.95
Economic category	desp_pess_enc_cpt	(+)	(+)					Per capita staff expenditure	pib_cpt	(-)	0	0		0		Per capita GDP
	odc_cpt	(+)	(+)		(+)	(+)		Per capita other current expenditure	gini_renda_cpt_2010	(-)	(-)			(+)		Gini index of per capita income
	invest_cpt					(+)		Per capita investment	idhm_2010	(+)	(+)	(+)		(-)		MHDI
Sub-function	liq_sub_adm_cpt	(+)	(+)	(+)	(+)	(+)	(+)	Per capita administrative sub-functions	IDS	(+)	(+)	(+)	(+)	(+)	(+)	2015 health development index
	liq_sub_vinc_cpt	(+)	(+)	(+)				Per capita linked sub-functions	ind_mort_0a4_ 10000		(+)	(+)		(+)	(+)	Avoidable deaths from 0 to 4 years
	liq_atbas_cpt					(+)	(+)	Per capita PHC expenditure	ind_mort_5a74_ 1000		(-)				(+)	Avoidable deaths from 5 to 74 years
PHC expenditure blocks	atbas_fed_cpt	(+)	(+)		(+)	(+)		Per capita federal PHC expenditure
	atbas_est_cpt					(+)		Per capita state PHC expenditure
	atbas_rprop_cpt					(+)		Per capita municipal PHC expenditure
Total expenditure blocks	tot_fed_cpt	(+)	(+)	(+)	(+)	(+)		Total per capita federal expenditure
	tot_est_cpt							Total per capita state expenditure
	tot_rprop_cpt							Total per capita municipal expenditure
Total expenditure	desp_geral_cpt	(+)	(+)			(+)		Per capita general expenditure

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[1] Collaborators

HK Kashiwakura: responsible for all quantitative tests, organized the entire researche’s database and wrote the text. AO Gonçalves: led the process of research and organized the entire text for the elaboration of this article. RR Azevedo: checked all the quantitative tests and made the necessary adjustments, and also revised the entire article. A Nunes: defined together with the authors the discussions of the results and conclusions of the article. CAT Silva: adapted the methodological content in the article.