Financiamento na saúde pública: análise de indicadores de gastos na Região Metropolitana de Belém

Abstract

Based on the theories of situational strategic planning by Carlos Matus and urban planning and socio-spatial development by Marcelo Lopes de Souza, this work establishes reflections on health financing in the Metropolitan Region of Belem (RMB) - formed by the municipalities of Belém, Castanhal, Santa Izabel, Marituba, Benevides, Ananindeua and Santa Bárbara-,; in particular, on expenses and (in)permeability involving the municipalities that comprise it. In this portion of the city, all the municipalities that comprise it establish a dynamic flow among themselves, making conventional planning not as fruitful as it could be. The right to health is universal and essential to every citizen and constitutionally enacted, and must be enjoyed, in fact, by the inhabitants and guaranteed by the State. The main objective of this research is to analyze the behavior of these expenses in the time frame of 11 years and their contradictions in the practice of planning, as well as to situate the social actors involved in this process, considering the socio-spatial diversity of the analyzed reality. To carry out the study, the following methodological procedures were used: a) theoretical-conceptual bibliographic review of relevant themes, theories, concepts and notions; b) bibliographic review of a historical geographical nature and survey of primary and secondary data on the Metropolitan Region of Belém, as well as on public policies relevant to the issue of planning; c) collection and analysis of data regarding funding, resources, effectiveness and efficiency, available in PROADESS (Project Assessment of the Performance of the Health System). The results showed that: a) the form of planning used cannot optimize citizens' access to health in the Metropolitan Region of Belém; b) personnel expenses were higher than those for equipment, and Santa Izabel and Santa Bárbara are the least equipped municipalities; c) the municipalities are quite dependent on transfers from the Union and, of all of them, including own resources and transfers from the Unified Health System (SUS), Marituba emerges as the municipality with the lowest performance. As for health care. In general, we found that the planning developed by the federated entities of the RMB does not satisfy its citizens in order to achieve an integrated management from the metropolitan point of view, causing access to health to be restricted to only a portion of the population.