Financiamento do SUS e emendas parlamentares : uma análise da desigualdade das transferências de incremento ao custeio de serviços no período de 2019 a 2024

This study investigates the role of parliamentary amendments in the financing of Brazil's Unified Health System (SUS), with an emphasis on increased funding transfers for primary and specialized healthcare between 2019 and 2024. First, it analyzes the evolution of the annual funding limits defined by the Ministry of Health for this type of transfer, revealing a significant increase over the period - particularly in specialized care. In this level of healthcare, the funding ceilings for state public facilities increased by 147%, while those for municipal public facilities grew by 231%. During the same period, the actual amounts paid rose by 79% and 120%, respectively. For primary care, the increase in paid amounts was 51%. The analysis also highlights sharp disparities among federative entities in terms of per capita resources received. Second, the study examines increased funding transfers for specialized care to private non-profit entities, based on a novel dataset constructed through the analysis of 745 ordinances issued by the Ministry of Health during the period. The collected data show that 34.1% of amendments directed to states and 28.1% of those to municipalities for this type of expenditure were allocated to private providers. Finally, the study analyzes expenditures executed in 2023 using funds initially reserved for rapporteur amendments but later reclassified as discretionary spending (i.e., not originating from parliamentary amendments), following a Supreme Federal Court (STF) decision stating that such amendments should only be used to correct errors and omissions in the federal budget. The findings reveal significant disparities in the allocation of these resources across subnational entities. In primary care, Alagoas was the most benefited, receiving R$ 72 per capita in municipal transfers, followed by Roraima (R$ 36) and Piauí (R$ 34). In specialized care, Alagoas again received the highest amount - R$ 128 per capita in state and municipal transfers - followed by Maranhão (R$ 49) and Paraíba (R$ 44).