Balances of federal transfers in SUS: what we have and what to expect from the COVID-19 increment

Faleiros, Daniel Resende; Pereira, Blenda Leite Saturnino

doi:10.1590/1413-812320212611.13712021

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FREE THEMES • Ciênc. saúde coletiva 26 (11) • Nov 2021 • https://doi.org/10.1590/1413-812320212611.13712021 copy

Balances of federal transfers in SUS: what we have and what to expect from the COVID-19 increment

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

We analyzed the balances from the transfers from the Ministry of Health (MH) to subnational entities, to finance the Unified Health System (SUS), including for COVID-19. We verified the representativeness of these in relation to the transfers from the MH to public health actions and services, between 2019and 2020. We analyzed the MH ordinances that gave rise to the COVID-19 transfers, classifying them as: quantity; object; apportionment criterion; amount of installments; execution linked to MH strategies; value. More than 70.000 current accounts were accounted for, and some subnational entities had more than 100. In 2019, balances reached R$16.29 billion (annual increase of 10.2%), representing 19.9% of the total transferred. In 2020, they reached R$23.83 billion (an increase of 46.3%), representing 21.1% of all transfers, with a monthly trend of continued growth. More than 616 ordinances, with 28 different objectives, transferred R$32.30 billion to COVID-19. The resource, originally freely available, had R$11.88 billion (36.8%) linked to the strategies of the MH: R$1.36 billion (99.9%) linked to the Structuring Block, and R$10.52 billion (34.0%) linked to the Maintenance Block. There are several causes that give rise to the accumulation of balances, however the quality, quantity and complexity of the SUS normative framework strongly contribute to an execution of resources that is not very fast, effective, efficient and useful.

Key words:
Public health; Health economic; Budgets

Data	Amounts related to the budgets of the Ministry of Health
Source	Integrated Planning and Budget System - SIOP
Access	https://www.siop.planejamento.gov.br/modulo/login/index.html#/
Period	Years 2019 and 2020
Inquiry	Federal Budget Panel
	Budget Body	36000/MS
	Budget Unit	36211/FNS
	Application Types	31; 35; 41; 45 (Fund-to-Fund Transfers to States, Federal District and Municipalities)
	Values	Current endowment (resources made available); Committed; Paid
	Types of actions	Ordinary; 21C0 Confronting the Coronavirus Public Health Emergency of International Concern; 2E89 Temporary Increase in the Cost of Primary Health Care Services to Fulfill Goals; 2E90 Temporary Increase in the Cost of Hospital and Outpatient Care Services to Fulfill Goals
Data	Amounts related to current accounts and balances
Source	Portal Localiza SUS/MS with FNS primary bases
Access	https://localizasus.saude.gov.br/
Period	Years 2019 e 2020
Inquiry	FNS - BALANCE FOLLOW UP	Number of accounts
		Account balance amount
		Management sphere
		Type of account
Data	Amounts of transfers to COVID-19
Source	National Health Fund (FNS)
Access	https://portalfns.saude.gov.br/consultas/
Period	Year 2020
Inquiry	Day transfer	Year/Month
		Transfers
		Blocs
		CORONAVIRUS Group (COVID-19)
		State/Municipality
		Instrument
		Value

Budget Body	36000 - Ministry of Health
Budget Unit	36901 - National Health Fund
Application modality	2019				2020 - Total				2020 - Only COVID-19
	C. Alloc.	Repres.	Comm.	Paid	C. Alloc.	Repres.	Comm.	Paid	C. Alloc.	Repres.	Comm.	Paid
	R$ billion	%	%	%	R$ billion	%	%	%	R$ billion	%	%	%
30 - Transfers to States and the Federal District	0,31	0,2	95,4	6,1	0,31	0,2	98,5	3,5	-	-	-	-
31 - Transfers to States and the Federal District - Fund-to-Fund	20,97	16,5	99,7	96,8	29,73	23,4	99,9	95,6	9,89	7,8	99,8	90,9
32 - Budget Execution Delegated to States and the Federal District	0,00	-	-	-	0,02	-	-	-	-	-	-	-
35 - Fund-to-Fund Transfers States/Federal District (rest to be paid)	0,21	0,2	100,0	100,0	0,01	0,0	100,0	100,0	-	-	-	-
40 - Transfers to Municipalities	0,31	0,2	88,2	11,8	0,13	0,1	94,9	46,1	0,00	0,0	-	-
41 - Transfers to Municipalities - Fund-to-Fund	60,54	47,6	99,4	96,9	82,95	65,2	99,8	97,8	23,37	18,4	99,8	99,0
45 - Fund-to-Fund transfers to Municipalities (rest to be paid)	1,26	1,0	100,0	100,0	0,87	0,7	100,0	100,0	-	-	-	-
50 - Transfers to Private Non-Profit Institutions	1,40	1,1	96,2	57,6	1,46	1,1	99,0	58,8	0,14	0,1	100,0	50,9
70 - Transfers to National Multigovernmental Institutions	0,01	0,0	95,8	8,8	0,01	0,0	92,7	6,4	-	-	-	-
71 - Transfers to Public Consortia by means of an apportionment contract	0,00	-	-	-	0,00	-	-	-	-	-	-	-
80 - Transfers Abroad	0,90	0,7	99,8	93,8	2,88	2,3	99,8	97,2	1,62	1,3	100,0	98,3
90 - Direct Applications	39,61	31,1	99,3	79,9	64,64	50,8	65,5	52,0	28,98	22,8	24,4	19,3
91 - Direct Application Resulting from Interagency Operations	1,67	1,3	91,2	91,0	1,48	1,2	97,1	93,0	0,16	0,1	100,0	65,1
99 - TO BE DEFINED	0,00	0,0	-	-	0,00	0,0	-	-	0,00	0,0	-	-
Total	127,19	100,0	99,3	90,6	184,49	145,0	87,8	80,8	64,17	50,4	65,7	61,5

Amount of ordinances	Number of the Ordinances	Block / Transfer Object	Resource apportionment method	Number of transfer installments	Type of linkage of the transfer	Total amount transfer (R$)
30	-	Structuring the Public Health Services Network (INVESTMENT)				1.366.838.778,00
14	Various	Acquisition of permanent equipment and materials	N/I	Only one	Action + proposal	387.637.631,00
2	3393 3474	Computerization of eSF and eAP	Non-computerized eSF and eAP and membership requests	Only one	Action + strategy object	384.325.864,00
1	3717	Strengthening of SVO	Coverage area population	Only one	Action + strategy object	210.000.000,00
9	Various	Parliamentary Amendment	Policy	By amendment	Action + object amendment	192.794.872,00
3	3389 3391 3473	Structuring and adapting dental care environments	eSB/CEO	Only one	Action + strategy object	128.033.476,00
1	3248	Structuring of the NIP's Cold Chain and Epidemiological Surveillance units	Cold Chain and Influenza Sentinel Surveillance	Only one	Action + strategy object	62.295.950,00
N/I	N/I	N/I	N/I	N/I	N/I	1.750.985,00
586	-	Maintenance of Public Health Actions and Services (COST)				30.933.649.845,51
4	480 774 859 1666	Cost of health actions and services	Population; PAB; MAC; PHC; ICU beds; COVID-19 incidence rate	Only one	Action	18.344.496.933,12
349	Various	Enabling ICU beds	Beds	By qualification	Action + strategy object	3.915.710.256,00
75	Various	Parliamentary Amendment	Policy	By amendment	Action + object amendment	2.242.118.251,00
2	1393 1448	Santas Casas and non-profit philanthropic hospitals	SUS beds	Only one	Action	2.000.000.000,00
11	Various	Service Centers	Per capita	By registration	Action + strategy object	681.495.730,00
1	2516	Acquisition of mental health medications	HDI	Only one	Action + strategy object	649.833.472,83
1	1857	Health at School Program	Schools	Only one	Action + strategy object	454.331.202,00
1	395	MAC actions	Per capita	Only one	Action + strategy object	424.154.750,00
1	2358	Contact tracking and monitoring	Health professional	Only one	Action + strategy object	369.708.000,00
1	2405	Strengthening PHC teams and services in the care of specific populations	eSF; eAP; eSFR; eCR; UBSF; eAPP;	Only one	Action + strategy object	319.429.740,00
1	2624	Surveillance, Alert and Response	Centers; Units	Only one	Action + strategy object	295.500.000,00
1	2222	Pregnancy, Prenatal and Puerperium Support	Pregnant; Puerperal; eSF; eAP; House of support	Only one	Action + strategy object	259.888.395,00
1	2994	Attention to people with obesity, diabetes mellitus or systemic arterial hypertension	eSF; eAP	Only one	Action + strategy object	221.811.937,50
1	2782	Immunization and surveillance	Reference centers; sentinel units	Only one	Action + strategy object	126.080.000,00
1	430	Extended hours of FHU or BHU	FHU; BHU	By competence / goal	Action + strategy object	125.385.000,00
1	3350	RAPS Services	CAPS modality	Only one	Action + strategy object	99.092.276,75
12	Various	Beds in HPP	Beds	By bed	Action + strategy object	88.218.000,00
118	Various	Lung Ventilatory Support Beds	Beds	By qualification	Action + strategy object	79.680.998,40
1	2574	Philanthropic hospitals	Policy	Only one	Action	70.012.881,05
1	2625	Strengthening of SVO	Coverage area population	Only one	Action + strategy object	66.375.000,00
1	3008	Reorganization and adaptation of the environments for dental assistance	CEO	Only one	Action + strategy object	62.023.720,00
1	827	Hemodialysis session value complementation	Procedures	Only one	Action + strategy object	36.724.207,61
N/I	N/I	N/I	N/I	N/I	N/I	1.579.094,25
616	-	Grand Total				32.300.488.623,51

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[1] Collaborations

DR Faleiros and BLS Pereira: Study design and governance; Write-up and ongoing critical review of the article; Materials/analysis tools; Ongoing study review and feedback regarding design, data collection, analysis and critical review of the manuscript; All authors had full access to all of the data and take responsibility for the integrity of the data and the accuracy of the data analysis.