The department and state funding of the Unified Health System (SUS) from the perspective of regional equity: case study of Rio de Janeiro

Trata-se do estudo do caso do Estado do Rio de Janeiro, no per??odo compreendido entre 2003 e 2006. Analisa o papel da inst??ncia estadual na distribui????o geogr??fica (municipal e regional) dos recursos financeiros para o financiamento do Sistema ??nico de Sa??de e prop??e-se contribuir para a operacionaliza????o de formas mais justas de aloca????o dos recursos. O estudo emp??rico, de natureza quantitativa, analisou as receitas p??blicas realizadas pelos munic??pios do estado RJ e as despesas liquidadas pelo Estado RJ durante o mesmo per??odo. A an??lise constou de tr??s momentos. Primeiro: evolu????o das condi????es de financiamento em sa??de do governo estadual e do conjunto dos munic??pios do Estado do Rio de Janeiro. Segundo: possibilidade de interfer??ncia do governo estadual na capacidade de gasto dos munic??pios do Estado RJ. Terceiro: aloca????o equitativa de recursos segundo crit??rios de necessidades de sa??de. As distintas fontes de receitas foram agrupadas de modo a conferir certa racionalidade na compreens??o de como se estrutura o financiamento do SUS considerando a l??gica federativa que preside ao sistema de partilha de recursos no caso geral do Brasil e, especificamente, no caso do Estado RJ. O estudo foi norteado pela concep????o de equidade operacionalizada atrav??s da defini????o de igualdade de oportunidades de Sen (2008), al??m da defini????o de igualdade de condi????es, da tipologia de Turner (1986). Observou-se que os crit??rios de aloca????o entre as esferas federativas n??o foram suficientes para garantir a equidade. Os munic??pios, tanto quanto as regi??es de sa??de, apresentam condi????es de financiamento bastante d??spares, relacionadas ??s caracter??sticas do desenvolvimento regional, ?? import??ncia de determinadas fontes de recursos em detrimento de outras, ??s condi????es de elegibilidade para o recebimento de transfer??ncias constitucionais e legais, ?? capacidade fiscal e a outras condi????es. A principal fonte de financiamento da sa??de no Estado RJ ?? a receita pr??pria municipal. As transfer??ncias federais para a Aten????o B??sica n??o modificam essa disparidade inter-regional. As transfer??ncias federais para a m??dia e alta complexidade favorecem os munic??pios com maior capacidade instalada, consolidando as desigualdades existentes. Os recursos estaduais transferidos aos munic??pios n??o alteram as caracter??sticas das desigualdades no financiamento da sa??de.This is the case study of Rio de Janeiro, in the period between 2003 and 2006. Examines the role of the instance state in the geographical distribution (municipal and regional) financial resources for financing the Health System and aims to contribute to the operation of more equitable allocation of resources. The empirical, quantitative, reviewed the revenue made by municipalities in RJ and RJ expenses paid by the State during the same period.The analysis consisted of three stages. First, changing conditions in health funding from the state government and all the municipalities of Rio de Janeiro. Second, the possibility of government interference in state spending capacity of municipalities in the state RJ. Third, equitable allocation of resources according to criteria of health needs. The different sources of revenue were grouped so as to give some rationality in the understanding of how to structure the financing of SUS considering the logic which governs the federal system of resource sharing in the general case of Brazil and, specifically, in the case of RJ State.The study was guided by the concept of equality operationalized through the establishment of equal opportunities Sen (2008), beyond the definition of equal conditions of the typology of Turner (1986). It was observed that the criteria for allocation between the federal spheres were not sufficient to ensure equality. The municipalities, as far as health regions, have conditions of very disparate funding related to the characteristics of regional development, the importance of certain sources of funds over others, the eligibility criteria for receiving legal and constitutional transfers, the fiscal capacity and other conditions.The main source of health financing in the State's own revenues RJ municipalities. Federal transfers for Primary Health Care not alter the interregional disparity. Federal transfers to the medium and high complexity favor the municipalities with greater capacity, reinforcing existing inequalities. The state funds transferred to municipalities do not alter the characteristics of inequalities in health financing