Efeitos na eficiência e produtividade dos serviços públicos de saúde com a implantação da Ementa Constitucional do Teto dos Gastos Públicos

Abstract

Capitalism has forced developing countries' governments to implement fiscal austerity policies in recent decades, as well as put pressure on the social right to health, as a condition for increasing the efficiency and productivity of health systems. In Brazil, due to the 2014 crisis that peaked in the approval of Constitutional Amendment (EC) No. 95/2016, the New Fiscal Regime was inaugurated, which imposed a freeze on primary government spending for 20 years, preventing its growth above inflation. The limits are imposed on the federal government, however, due to the division of responsibilities, decentralization of actions and public health services (ASPS) and the processes of pacts between the federated entities, the municipalities are the most affected due to being the main enforcers of the Brazilian Unified Health System (SUS), and relying primarily on funding transfers. From this perspective, this study aims to analyze the efficiency and productivity of municipalities regarding resource allocation and health services provision before and after the effectiveness of EC No. 95/2016. This research is classified as descriptive regarding its goals and quantitative regarding its means. The sample gathers 137 municipalities of the State of Ceará and the data from 2014 to 2019 were collected from government portals. Descriptive statistics, correlation tests, a combination of the DEA method and the Malmquist Productivity Index (MPI), both output-oriented, and tests for differences between means have been employed. The following analytical factors were applied: inputs - public spending on health per capita, percentage of revenue invested in ASPS and health teams per thousand inhabitants; outputs - vaccination coverage, inverse of infant mortality rate, outpatient production per capita, and number of available inpatient beds in the SUS per thousand inhabitants. The results indicate that prior to the EC, the efficiency mean was 3.38% higher than after the EC, and that there is a high efficiency mean for the municipalities in both periods. The individual analysis of productivity showed divergent findings from those of efficiency, denoting that, on average, no municipality increased productivity between the periods under analysis; however, there was a 3.5% increase in productivity in the sample when comparing the periods before and after the EC implementation. Furthermore, the results of the MPI and the mean tests indicated that the municipalities that increased their spending per capita on health, on average, have not increased their total productivity, corroborating some national research studies. It was concluded that, in general, the EC No. 95/2016 has negatively affect efficiency, while it has positively affect the Malmquist total productivity. However, the average productivity has declined in the two final analyzed years, indicating that the greatest impacts of the EC may occur over upcoming years of its effectiveness. This study's main contribution is to enable further discussions on the impacts of the so called spending cap amendment on municipal efficiency and productivity.