A estrutura orçamentária e sua produtividade na gestão da saúde pública no Brasil

Abstract

This research had the objective of identifying and analyzing how the budget structure influences the productivity of public expenditures in the health of the municipal network. Based on theories of fiscal federalism and public choice, as well as based on empirical studies, a budget structure divided between operational, administrative and investment expenditures was admitted. The Malmquist Index and Data Envelopment Analysis (DEA) were adopted as productivity metrics. To do so, we used variables that denote quantitative and qualitative aspects of public health: vaccines, medical examinations, medical visits, prenatal follow-ups, live births, and infant nutrition rate. This was done using the Chalos (1997) model of panel data with fixed effects to verify the relationships proposed in the hypotheses. The sample used resulted in 1,955 municipalities of the Brazilian federation and the analyzed period covered the last two municipal administrations, from 2009 to 2014. Thus, the results indicated that 36% of the municipalities analyzed presented efficient resource allocations. Regarding the budget structure, it was verified that the municipalities have not presented efficient expenditures, mainly in the heading investments. Regarding administrative and operational expenses, although no statistical significance was observed, they denoted productivity. In addition, it was found that discretionary health contributions do not lead to satisfactory results and are therefore considered disorderly or surplus expenditures. Regarding the managed own resources, the municipalities with the highest amount of own resources were identified, which have greater results in the management of public health. The results of this research contribute to the improvement of public health management in Brazil and are adherent to the national and international research identified, as well as theories of fiscal federalism and public choice.