A methodology for apportioning federal SUS resources: the health needs index

ABSTRACT OBJECTIVE To present a methodology for apportioning Union resources to the federative units (FU – 26 states and one federal district) within the Brazilian Unified Health System (SUS) based on health needs measured by demographic, socioeconomic, epidemiological and geographical dimensions. METHODS The apportionment methodology proposal prioritizes the health needs axis, based on Law 141/2012. We adopted a proxy of needs that measures relative inequalities between, socioeconomic, geographic demographic and epidemiological conditions of the populations of the Brazilian Federative Units (FU) for 2015. We first used an adjustment so that the populations of the 27 FU are corrected by their relative needs regarding age and gender. To calculate the health needs axis, the multivariate techniques factorial analysis and principal components were used, and, based on such correction, we applied the health needs index. Subsequently, this index was applied to simulate the resources that should be transferred by the Ministry of Health to states in 2015. RESULTS As we made the methodological choice of transferring a single per capita amount to all states, so the proposal required population correction. Thus, in the analysis of health needs, the FUs that had their population corrected by a factor higher than the national average because of their greater relative need, were the states of: Maranhão, Piauí, Alagoas, Paraíba, Ceará, Pará, Bahia, Acre, Pernambuco, Rio Grande do Norte, Sergipe, Amazonas, Tocantins and Roraima. For the simulation aggregating all the financing blocks, without reducing the resources already distributed to the remaining states in 2015, indicated the additional need of R$ 4.6 billion. CONCLUSIONS The proposal addresses the absence of studies presenting quantitative simulations of federal resources distribution within the scope of SUS to the FUs, based on the apportionment criteria defined by Law 141/2012, in order to contribute to the reduction health inequalities and mitigate the effects of the economic crisis.

摘要

## 研究目的
提出一种分配方法，用于基于人口、社会经济、流行病学及地理维度所衡量的健康需求，向巴西统一卫生系统（Brazilian Unified Health System, SUS）内的联邦单位（Federative Units, FU——含26个州与1个联邦区）分配联邦政府资源。

## 研究方法
本分配方法方案以第141/2012号法律为依据，以健康需求为优先考量维度。我们采用需求代理指标，对2015年巴西各联邦单位（FU）人口在社会经济、地理、人口学及流行病学条件间的相对不平等程度进行衡量。首先开展校正调整，依据各联邦单位人口在年龄与性别层面的健康需求差异，对27个联邦单位的人口数据进行校正。为计算健康需求维度指标，我们采用了多元统计技术中的因子分析与主成分分析法，并基于此次校正结果构建健康需求指数。随后，利用该指数模拟巴西卫生部应于2015年向各州拨付的资源规模。

## 研究结果
由于本研究在方法学上选择向所有州统一拨付人均资源，因此本方案需要进行人口校正。据此，在健康需求分析中，因相对健康需求更高而使得人口校正系数高于全国平均水平的联邦单位包括：马拉尼昂州、皮奥伊州、阿拉戈斯州、帕拉伊巴州、塞阿拉州、帕拉州、巴伊亚州、阿克里州、伯南布哥州、北里奥格兰德州、塞尔希培州、亚马孙州、托坎廷斯州、罗赖马州。本次模拟整合了所有融资板块，且未削减2015年已拨付给其余各州的资源，结果显示额外需拨付资金46亿雷亚尔。

## 研究结论
本方案填补了现有研究空白：目前尚无基于第141/2012号法律规定的分配标准，针对巴西统一卫生系统内联邦资源向联邦单位分配开展定量模拟的相关研究。本方案旨在助力减少健康不平等，并缓解经济危机带来的负面影响。