O financiamento estadual para estratégia saúde da família no estado de Mato Grosso 2003 a 2011

Abstract

The productive restructuring process has brought flexibility and job insecurity, and the neoliberalism has brought privatization, focus and reduction of the State through its counter-reformation, aiming at the capital preservation (reproduction). And the Public Fund, thereafter, tends to be crucial in this process. This paper presents an analysis on the financing and spending of social policies, especially for health, from the new world order. The overall objective is to analyze the state funding for the Family Health Strategy - FHS in the state of Mato Grosso, in the period from 2003 to 2011, as a condition for its materialization. The specific objectives are: to analyze the counter-reformation at the Unified Public Health System (SUS, in Portuguese) in Mato Grosso; to analyze the implementation of the Family Health Strategy from its regulatory framework; to discuss the financing of the State Secretariat of Health in Mato Grosso; to analyze the budget of Mato Grosso for the health care, especially primary care and the Family Health Strategy in planning instruments: Multiannual Plan, Budget Guidelines Law and the Annual Budget Law and State Health Plans. The method used is the historical and dialectical materialism. Secondary data on the budget between 2003 and 2011 were collected in the Budgetary Laws, State General Balance, SIG-MT, Systems of Information on Public Budgets in Health – SIOPS (in Portuguese), DATASUS, whose amounts are those paid deflated by the General Prices Index - Internal Availability (IGP-DI, in Portuguese), using the 2012 prices. At first, the results showed divergence between the government's economic team and the Secretariat’s, because before the EC 29/00 there was prioritization of health in the documents. However, that did not occur in the allocation of resources. Subsequent to the EC, the binding of revenue allowed relative autonomy and increased resources for the department and there is a prioritization in the allocation of resources for the Family Health Strategy. But this behavior did not remain in the other years. What is noticeable, since then, is that the direction taken leads to the concentration of spending on some expenses such as personnel, with medium and high complexity and medicines, as well as a steady reduction in the amounts allocated and executed for the Family Health Strategy. That is a contradiction as it leads us to the conclusion that the population is sicker due to the increase in expenses in these areas, which could be resolved through a resolutive primary attention. This higher allocation for the medium and high complexity has provided an increase in the transfers to non-profit private entities. The magnitude reinforces that non-prioritization of this level of attention, because when compared with GDP or with other policies of the state its participation is insignificant. It is not possible to consolidate not even promote a change in the model of health care legislation in the country. It is necessary to enhance Primary Health Care as a key part to the consolidation of SUS.