The challenges of funding the Brazilian health system in fighting the COVID-19 pandemic in the context of the federative pact

Abstract The improvement of rules to fund the Brazilian health system (SUS) in states and municipalities is one of the major public health challenges in Brazil. The purpose of this article is to contribute to this broad debate, analyzing the government's response to the challenge of combating COVID-19, from the perspective of public financing of health services of Brazilian subnational governments. A qualitative and quantitative approach is adopted, combining documentary analysis and regression analysis. The results show that there was no substantive change in the criteria for transfers, which are not sensitive to epidemiological factors. Adjustments to the application rules were made to speed up spending. Population size, production of local wealth, and the number of hospital beds are the main factors that define the distribution of resources. The funding design for combating COVID-19, as well as the volume of resources, are insufficient in view of the scale of the crisis.

摘要：完善巴西各州与市级卫生系统（SUS）的资金拨付规则，是巴西公共卫生领域面临的重大挑战之一。本文旨在为这一广泛讨论贡献研究视角，从巴西地方政府卫生服务公共融资的维度，剖析政府应对新冠疫情防控挑战的举措。本研究采用定性与定量相结合的研究方法，整合档案分析与回归分析手段。研究结果显示，现有资金拨付标准未发生实质性调整，且该标准未受流行病学因素影响。为加快资金支出进度，相关部门对资金使用规则作出了调整。人口规模、地方财富产出以及医院床位数，是决定资源分配的核心影响因素。结合本次疫情危机的规模来看，新冠疫情防控的资金规划及资源投入总量均显不足。