Behavior and determinants of federal health transfers in Brazil: a spatial analysis

Abstract

Conceived by the 1988 Constitution, the Brazilian Unified Health System targets fiscal decentralization and the equitable distribution of funds towards states and municipalities. Through an Exploratory Spatial Data Analysis and the estimation of a spatial lag model (SAR) via Generalized Method of Moments (GMM), we aimed to identify the behavior and determinants for the federal transfers to Brazilian microregions, considering the spatial component. The spatial diagnosis indicated that microregions that received higher amounts of resources were neighbors of microregions that also obtained higher transfers. Econometric results showed that economically poorer microregions received greater amount of transfers. On the demand side, high complexity was prioritized over low; the reverse on the supply side, indicating a certain degree of ambiguity in the distribution of resources. Morbidity, number of physicians, low-complexity hospitals and political components were also crucial to attracting federal resources.

Keywords:
Spatial econometrics; Spatial models; Health economics; Public health; Intergovernmental transfers