Transferências voluntárias na saúde: um estudo de caso do município de São Paulo

Farias, Lauro Emilio Gonzalez
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The analysis of the financing of the Brazilian Unique Health System (SUS) is extremely complex. The most part of public health financing studyies focuses on the analysis of the legal and constitutional transfers (labelled also as “automatic”) of the Union and states to subnational governments, with few works devoted to the analysis of voluntary / discretionary transfers that occurs at the context of SUS. Such thematic or is ignored by the epistemic community or is treated only marginally in academic studies. In order to complement this unspoilt part of health literature, this dissertation conducts an exploratory analysis of the performance of discretionary transfers effected between the different levels of government, seeking algo to understand the relevance of this type of transfer for the health financing. Grounded on concepts extracted from the federalist theory the work seeks to understand the case of voluntary transfers in the health sector as an expression of coercive federalism. Beyond upgrading the SUS financing rules, it was held as one of the stages of analysis interviews with health managers, as well an analysis of secondary databases. As conclusions it was found from document analysis stage that the voluntary transfers can be configured as a tool that centralizes the decision-making in policies (Misoczky, 2003) since it imposes on municipalities the objectives drawn by higher governments and demonstrate a coercive relationship of federalism (Watts, 2006; Arretche, 2004). However, the data analysis of São Paulo allowed to relativize this in economic terms, given the low representation of voluntary transfers from the total expenditure in the health area.

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