The budget proposal for next year, sent by the Ministry of Economy to the National Congress at the end of August, foresees 149.9 billion reais for spending in this strategic area. This is the lowest value since 2019 and only BRL 39 million above the minimum established by lawwhich requires, at least, that the amounts be corrected for the inflation of the previous period.
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In addition to the loss of funds, there is always the fear of a loss of quality of expenditure. Indeed, almost R$10 billion of the rapporteur’s so-called amendments, known as the “secret budget”, have been used to compose the minimum amount needed for health for 2023, which analysts say will affect action planning in the sector.
According to a survey by the Brazilian Association of Health Economics (ABrES), a non-profit civil society, the cap rule, which prevented a real (above inflation) increase in spending in the region, withdrew R$36.9 billion from the SUS between 2018 and 2022. And it is expected to withdraw an additional R$22.7 billion in 2024.
Before the cap, which came into effect in 2017, the government would have to invest 15% of net current revenue in health stocks. According to this criterion, this would be a minimum expenditure of BRL 172.6 billion in 2024. An amount higher than the BRL 149.9 billion foreseen in next year’s budget.
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use of amendments
According to a joint bulletin of the Budgetary Councils of the Chamber of Deputies and the Federal Senate, to reach R$149.9 billion in health expenditure (minimum required by the expenditure ceiling rule), the government estimated that 9.7 billion R$ of tax amendments (individual and bench) and 9.9 billion reais of amendments of the general rapporteur (secret budget) will be allocated in this area.
The consultants point out that, according to the Constitution, half of the amount of individual amendments (5.9 billion reais) is allocated to this area. Regarding changes to the state bench, although there is no regulation linking this allocation, the Budget Orientation Law (LDO) of 2023 authorizes that up to half of the planned reserve for these modifications (3.8 billion reais) be freed for health.
As for the rapporteur’s amendments, there is no rule which obliges the assignment to Health. These amendments became known as the “secret budget” due to the lack of transparency and fairness in the distribution of resources.
Data from the Brazilian Association of Health Economics (ABrES) shows that during the Bolsonaro government alone, the percentage of participation in parliamentary amendments to the health budget almost tripled.
And, as parliamentary amendments gain space in the health budget, core programs in the portfolio shrink. Compared to 2022, the value of the rapporteur’s amendments increased by 22% and that of the charges by 13%.
already the funds for the following Ministry of Health actions have decreased:
- ↓ 61.2% structuring the stork sector;
- ↓ 59% Popular Pharmacy;
- ↓ 59% Indigenous health;
- ↓ 56% Health and Health Training;
- ↓ 46.4% cancer control;
- ↓ 36.8% National immunization program.
The data was compiled by ABrES and compares the 2022 budget with the 2023 budget proposal sent by the government to Congress.
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