Financiamento público da saúde no Brasil: fatores determinantes dos gastos estaduais

Abstract

Public health financing in Brazil is marked by historical tensions that combine chronic underfunding, economic instability, and federative inequalities, factors that weaken the effectiveness of the Unified Health System (SUS). Despite the constitutional milestone of 1988, which enshrined health as a universal right, the gap between normative principles and the material conditions for implementation remains a central challenge. In this context, understanding the determinants of state health expenditures is essential for assessing the system’s sustainability and guiding public policies. The objective of this dissertation is to analyze the trajectory of health expenditures in Brazil’s 26 states and the Federal District from 2014 to 2024, identifying the influence of demographic, socioeconomic, and institutional variables on budget allocation. To this end, a quantitative approach of descriptive and explanatory character was employed, grounded in econometric techniques of panel data, with information drawn from SIOPS, IBGE, and IPEADATA. Fixed- and random-effects models were tested, with corrections for heteroskedasticity, ensuring statistical robustness of the inferences. The results demonstrate that factors such as population aging, age structure, GDP, and GDP per capita exert significant impacts on health spending, highlighting the interdependence between demographic dynamics and fiscal capacity. The analysis further confirms that population composition and economic development are structural determinants of financing, with implications that go beyond accounting aspects and directly affect equity and the effectiveness of public policies. It is concluded that the sustainability of SUS depends on overcoming federative asymmetries and building institutional arrangements capable of reconciling efficiency, equity, and social justice.