SUS funding in the face of the Covid-19 pandemic

ABSTRACT The Brazilian Unified Health System (SUS), since its creation in 1988, has a history of insufficient resources to effectively guarantee universality and comprehensive care. Its underfunding, derived from the lack of support from part of society and neoliberal policies undertaken by various governments in the 1990s and 2000s, turned into effective reduction in real terms of funding resources after the approval of the “expenditure ceiling” in 2016, aggravating the structural system difficulty. The Covid-19 pandemic generated a preeminent need to expand the service capacity of the public health system and, with that, the resources for the SUS were expanded. However, this greater financial availability was the result of extraordinary measures and was restricted to the years 2020 and 2021. The ordinary budget for health in those years and the 2022 LOA demonstrate that the underfunding continues and that the pandemic did not change the lack of priority given to healthcare within the federal budget.

摘要 巴西统一卫生系统（SUS）自1988年创立以来，始终面临资源供给不足的困境，无法切实保障医疗服务的全民覆盖与全面性。该体系的资金短缺问题，源于部分社会群体的支持缺位，以及1990至2000年代历届政府推行的新自由主义政策；2016年“支出上限”政策获批后，实际可用资金进一步出现实质性缩减，加剧了该体系的结构性运营难题。
新冠疫情暴发后，公共卫生系统亟需扩容服务能力，巴西统一卫生系统的资源投入也随之增加。但此番财政支持均为临时性特殊应急举措，仅覆盖2020年与2021年两个年度。2020、2021年的常规卫生预算及2022年年度预算法案（LOA）数据显示，资金不足的现状仍在持续，新冠疫情并未改变联邦预算中医疗保健领域未获优先重视的局面。