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Title: Os impasses no financiamento do Sistema Único de Saúde na era da mundialização do capital
Authors: Couri, Joseane Rotatori
metadata.dc.contributor.email: joseane.couri@gmail.com
Orientador(es):: Salvador, Evilásio da Silva
Assunto:: Saúde
Financiamento
Estado
Fundo público
Issue Date: 28-Oct-2021
Citation: COURI, Joseane Rotatori. Os impasses no financiamento do Sistema Único de Saúde na era da mundialização do capital. 2021. 61 f., il. Tese (Doutorado em Política Social)—Universidade de Brasília, Brasília, 2021.
Abstract: Esta tese analisa o fundo público da política de saúde, no período de 2003 a 2020, em um contexto de mundialização do capital. Para se atingir tal fim, contextualizou-se o atual período de mundialização do sistema capitalista, em que prevalece a expansão do capital portador de juros e do capital fictício, de modo que eles assumem quase todo o comando do processo de acumulação capitalista. No citado período, houve uma acentuação da exploração da força de trabalho e uma ampla regressão dos direitos sociais conquistados pelos trabalhadores, e isso é ainda mais notável no capitalismo dependente brasileiro. O Estado possui um papel central para sustentar esse modelo de acumulação, principalmente por intermédio do fundo público, que assegura recursos públicos para a manutenção desse sistema, apesar de concretizar algumas políticas sociais. Buscou-se abordar o financiamento da política de saúde de uma maneira ampla, mas sem perder as suas peculiaridades. Abordou-se o financiamento direto da referida política por meio da análise do orçamento da seguridade social, dedicando-se a compreender a participação da citada política dentro do mencionado orçamento. Investigou-se o processo de descentralização do Sistema Único de Saúde (SUS), buscando-se evidenciar a participação de cada ente da Federação (União, estados, municípios e Distrito Federal) nos gastos orçamentários com essa política. Por fim, estudou-se o tema dos gastos tributários, também conhecidos como renúncias tributárias, bem como suas implicações no (des)financiamento da política de saúde pública. Essa análise demonstrou que o Estado realiza gastos indiretos com a saúde, renunciando a parcela importante da arrecadação de tributos em prol da oferta de serviços pelo setor privado. Para se compor o quadro teórico e analítico do financiamento, explorou-se a trajetória histórica da política de saúde, destacando as características que ela assume no Estado brasileiro. Dentre as normas estudadas, destacam-se a CF/88, a EC 29, a EC 89, a EC 95 e a LC no 101. Os dados orçamentários utilizados na análise do financiamento da política de saúde foram extraídos do sistema SIGA Brasil, desenvolvido pelo Senado Federal, e complementados com os relatórios produzidos pela Secretaria do Tesouro Nacional (STN). Além disso, foram analisados os demonstrativos dos gastos governamentais indiretos de natureza tributária que acompanham a Lei Orçamentária Anual. Dentre os resultados da pesquisa, destaca- se que, apesar dos avanços no SUS, o sistema ainda possui diversos desafios, principalmente quanto ao seu financiamento. Uma explicação que pode ser encontrada é devido às diversas contrarreformas em prol da acumulação capitalista, principalmente a partir de 2015, quando o País se encontra em um período de ajuste fiscal permanente e mais recentemente marcado pela política da austeridade fiscal permanente, o que facilita o processo de desfinanciamento e subfinanciamento crônico do SUS. Em segundo lugar, o Brasil possui papel dual no financiamento da saúde, porque financia, diretamente, por meio do fundo público, ações e serviços públicos de saúde e, indiretamente, por meio das desonerações tributárias, reforça o setor privado.
Abstract: This thesis analyzes the public health policy fund from 2003 to 2020, in a context of capital mundialization. To achieve this end, it contextualized the current mundialization period of the capitalist system, in which the expansion of interest-bearing capital and fictitious capital prevails, in which they assume almost all command of the capitalist accumulation process. During this period, there was an accentuation of the overexploitation of the labor force and a wide regression of social rights conquered by workers, and this is even more remarkable in Brazilian dependent capitalism. The State has a central role to support this accumulation model, mainly through the public fund, which ensures public resources for the maintenance of this system, despite implementing some social policies. It sought to address the financing of health policy in a broad way, but without losing its peculiarities. The direct financing of this policy was addressed through the analysis of the social security budget, dedicating itself to understanding the participation of this policy within this budget. The decentralization process of the Brazilian National Health System (SUS) was investigated, seeking to evidence the participation of each entity of the federation (Union, states, municipalities and Federal District) in the budgetary expenditures with this policy. Finally, tax expenditures, also known as tax waivers, and their implications for the (un)financing of public health policy were studied. This analysis showed that the State spends indirectly on health, renouncing an important portion of tax collection in favor of the provision of services by the private sector. To compose the theoretical and analytical framework of financing, the historical trajectory of health policy was explored, highlighting the characteristics it assumes in the Brazilian State. Among the norms studied, the following stand out: CF/88, EC 29, EC 89 and EC 95 and LC no 101. The budget data used in the analysis of the financing of health policy were extracted from the SIGA Brasil system, developed by the Federal Senate and complemented with the reports produced by the Secretary of the National Treasury (STN). In addition, the statements of indirect government expenditures of a tax nature that accompany the Annual Budget Law (LOA) were analyzed. Among the research results, it is highlighted that, despite advances in the SUS, the system still has several challenges, especially regarding its financing. One explanation that can be found is due to the various counter-reforms in favor of capitalist accumulation, especially from 2015, in which the country is in a period of permanent fiscal adjustment and more recent marked by the policy of permanent fiscal austerity, which facilitates the process of unfunding and chronic underfunding of the SUS. Second, Brazil has a dual role in health financing, as it finances, directly, through the public fund, public health actions and services, and indirectly, through tax exemptions, strengthening the private sector.
Resumen: This thesis analyzes the public health policy fund from 2003 to 2020, in a context of capital mundialization. To achieve this end, it contextualized the current mundialization period of the capitalist system, in which the expansion of interest-bearing capital and fictitious capital prevails, in which they assume almost all command of the capitalist accumulation process. During this period, there was an accentuation of the overexploitation of the labor force and a wide regression of social rights conquered by workers, and this is even more remarkable in Brazilian dependent capitalism. The State has a central role to support this accumulation model, mainly through the public fund, which ensures public resources for the maintenance of this system, despite implementing some social policies. It sought to address the financing of health policy in a broad way, but without losing its peculiarities. The direct financing of this policy was addressed through the analysis of the social security budget, dedicating itself to understanding the participation of this policy within this budget. The decentralization process of the Brazilian National Health System (SUS) was investigated, seeking to evidence the participation of each entity of the federation (Union, states, municipalities and Federal District) in the budgetary expenditures with this policy. Finally, tax expenditures, also known as tax waivers, and their implications for the (un)financing of public health policy were studied. This analysis showed that the State spends indirectly on health, renouncing an important portion of tax collection in favor of the provision of services by the private sector. To compose the theoretical and analytical framework of financing, the historical trajectory of health policy was explored, highlighting the characteristics it assumes in the Brazilian State. Among the norms studied, the following stand out: CF/88, EC 29, EC 89 and EC 95 and LC no 101. The budget data used in the analysis of the financing of health policy were extracted from the SIGA Brasil system, developed by the Federal Senate and complemented with the reports produced by the Secretary of the National Treasury (STN). In addition, the statements of indirect government expenditures of a tax nature that accompany the Annual Budget Law (LOA) were analyzed. Among the research results, it is highlighted that, despite advances in the SUS, the system still has several challenges, especially regarding its financing. One explanation that can be found is due to the various counter-reforms in favor of capitalist accumulation, especially from 2015, in which the country is in a period of permanent fiscal adjustment and more recent marked by the policy of permanent fiscal austerity, which facilitates the process of unfunding and chronic underfunding of the SUS. Second, Brazil has a dual role in health financing, as it finances, directly, through the public fund, public health actions and services, and indirectly, through tax exemptions, strengthening the private sector.
Description: Tese (doutorado)—Universidade de Brasília, Instituto de Ciências Humanas, Departamento de Serviço Social, Programa de Pós-Graduação em Política Social, 2021.
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Appears in Collections:SER - Doutorado em Política Social (Teses)

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