In Brazil, the debate on the role of parliamentary amendments (PAs) in federal funding for the Unified Health System (SUS) has gained prominence in recent years due to the increase in allocated amounts and the potential consequences for public access to health services, given the system's underfunding. In this context, aiming to contribute to the discussion on this topic, the objective of this text is to analyze the allocation of federal resources through PAs for the funding of public health actions and services (PHAS), especially primary health care (PHC) and specialized health care (SHC), from the regional organization perspective of the SUS. A descriptive study was conducted on the allocation of federal resources to the SUS, focusing on the budgetary and financial execution of the Ministry of Health (MH) in PHAS through PAs, from 2014 to 2023. Over the last ten years, MH expenses in PHAS through PAs increased by 371%, rising from BRL 4.9 billion in 2014 to BRL 23.0 billion in 2023, with a significant reduction in the MH's power to determine the allocation of resources for funding discretionary expenses. In 2023, the allocation of resources to municipalities through PAs for funding PHC and SHC, considering the regions and major health regions, was highly unequal. In the case of PHC, it promoted a greater concentration of resources in the major health regions and health regions of the North and Northeast of the country. In the case of SHC, these geographic regions were also benefited, but with higher per capita amounts concentrated in a smaller number of major health regions and health regions. Although the health regions of the North and Northeast received more resources, this does not necessarily mean improved access to specialized services for the population, which are less available in these regions, since the allocation by PAs disregards the regional planning arrangements for service provision and the population served in a health region or major health region in the SUS. Consequently, PAs may create more inequalities in access to health services and more health inequities in Brazil.
