São Paulo School of Business Administration, Getulio Vargas Foundation (FGV EAESP) and IEPS, São Paulo, Brazil.
Department of Economics, Insper, São Paulo, Brazil.
Health Econ. 2021 May;30(5):1082-1094. doi: 10.1002/hec.4241. Epub 2021 Mar 9.
In this paper we adopt a growth accounting projection model to estimate and characterize health-financing needs in Brazil as well as to assess the extent to which financing needs may diverge from spending capacity in the future. We estimate an annual increase of 0.71% in the share of projected financing needs relative to GDP, with excess growth rates being 0.74% and 0.69% for the public and private health sectors, respectively. Institutional reforms and public spending restrictions may leverage public-private segmentation in health financing throughout the next decades, thus potentially leading to losses of equity in the system. Our projections contribute to a scant empirical literature on health financing sustainability in low- and middle-income countries and shed light on the role of spending capacity and institutional constraints over the path towards universal health coverage.
本文采用增长核算预测模型来估计和描述巴西的卫生筹资需求，并评估未来筹资需求与支出能力之间可能出现的背离程度。我们估计，相对于 GDP，预测的筹资需求占比每年将增长 0.71%，公共和私营卫生部门的超额增长率分别为 0.74%和 0.69%。制度改革和公共支出限制可能会在未来几十年推动卫生筹资的公私分割，从而可能导致该体系的公平性损失。我们的预测为关于中低收入国家卫生筹资可持续性的稀缺实证文献做出了贡献，并揭示了支出能力和制度约束在实现全民健康覆盖道路上的作用。
