Distortions of parliamentary amendments to the equitable allocation of federal resources to the PAB

Vieira, Fabiola Sulpino; Lima, Luciana Dias de

doi:10.11606/s1518-8787.2022056004465

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Original Article • Rev. Saúde Pública 56 • 2022 • https://doi.org/10.11606/s1518-8787.2022056004465 copy

Distortions of parliamentary amendments to the equitable allocation of federal resources to the PAB

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

Analyze the implications of parliamentary amendments (EP) for the model of equitable allocation of resources from the Fixed Primary Care Minimum (PAB-Fixo) to municipalities in the period from 2015 to 2019.

METHODS

A descriptive and exploratory study was conducted on allocating federal resources to the PAB-Fixo and on the increment in the PAB by parliamentary amendment. The municipalities were classified into four groups according to degrees of socioeconomic vulnerability defined by the Ministry of Health for the allocation of PAB-Fixo resources. The transfers from the Ministry by parliamentary amendment were identified. The proportions of municipalities benefiting per group were analyzed by resources allocated from the PAB-Fixo and increment to the minimum by EP.

RESULTS

There were reduced resources allocated to the PAB-Fixo (from R$ 6.04 billion to R$ 5.51 billion, -8.8%) and increased increment to PAB by parliamentary amendment (from R$ 95.06 million to R$ 5.58 billion, 5.767%) between 2015 and 2019. The participation of municipalities by the group of those favored by EP was similar to that in the PAB-Fixo. In the proportion of resources for amendments, the municipalities of group I (most vulnerable) had more participation, and those of group IV had less participation if compared to the allocation of the PAB-Fixo. The distribution of resources by the parliamentary amendment did not cover all municipalities, even the most vulnerable ones, i.e., belonging to groups I and II. There was great inequality of resources per capita according to the groups of municipalities.

CONCLUSION

The EP distorted the model of equitable allocation of resources proposed by the Ministry of Health for the PAB-Fixo, by allocating resources in a much more significant proportion to the municipalities of group I and much less to those of group IV, which is in disagreement with this model. Furthermore, this distribution by amendments does not benefit all municipalities, not even the most vulnerable.

Health Care Rationing, legislation & jurisprudence; Unified Health System; Financing, Government; Public Expenditures on Health; Healthcare Disparities, economics

Regions	PAB-Fixo resource allocation groups								Total

	I		II		III		IV

	n	Group (%)	n	Group (%)	n	Group (%)	n	Group (%)	n	Group (%)
2015, 2016, and 2017 - All municipalities (PAB-Fixo)
CW	273	10.5	162	7.9	27	3.6	5	3.0	467	8.4
NE	1,079	41.4	621	30.3	81	10.8	13	7.9	1,794	32.2
N	261	10.0	152	7.4	34	4.5	3	1.8	450	8.1
SE	617	23.7	600	29.3	348	46.3	103	62.8	1,668	29.9
S	374	14.4	516	25.2	261	34.8	40	24.4	1,191	21.4
Total	2,604	100.0	2,051	100.0	751	100.0	164	100.0	5,570	100.0
2015 - Municipalities benefited from the increment in the PAB by parliamentary amendments
CW	0	0.0	0	0.0	0	0.0	0	0.0	0	0.0
NE	49	35.3	30	26.3	4	7.7	2	22.2	85	27.1
N	16	11.5	15	13.2	3	5.8	0	0.0	34	10.8
SE	42	30.2	30	26.3	26	50.0	5	55.6	103	32.8
S	32	23.0	39	34.2	19	36.5	2	22.2	92	29.3
Total	139	100.0	114	100.0	52	100.0	9	100.0	314	100.0
2016 - Municipalities benefited from the increment in the PAB by parliamentary amendments
CW	14	1.6	4	0.6	4	1.2	0	0.0	22	1.1
NE	361	41.2	188	25.9	36	11.2	4	8.2	589	29.9
N	78	8.9	49	6.8	12	3.7	1	2.0	140	7.1
SE	231	26.3	215	29.7	135	42.1	30	61.2	611	31.0
S	193	22.0	269	37.1	134	41.7	14	28.6	610	30.9
Total	877	100.0	725	100.0	321	100.0	49	100.0	1,972	100.0
2017 - Municipalities benefited from the increment in the PAB by parliamentary amendments
CW	104	6.2	60	4.4	8	1.6	2	2.2	174	4.8
NE	699	42.0	428	31.4	54	10.8	8	8.8	1,189	32.8
N	203	12.2	112	8.2	16	3.2	1	1.1	332	9.2
SE	394	23.7	391	28.7	229	45.7	54	59.3	1,068	29.5
S	265	15.9	372	27.3	194	38.7	26	28.6	857	23.7
Total	1,665	100.0	1,363	100.0	501	100.0	91	100.0	3,620	100.0
2018 and 2019 - All municipalities (PAB-Fixo)
CW	411	10.4	33	2.9	18	4.6	5	5.3	467	8.4
NE	1,608	40.6	123	10.9	52	13.4	11	11.7	1,794	32.2
N	379	9.6	44	3.9	23	5.9	4	4.3	450	8.1
SE	957	24.2	464	41.1	190	49.0	57	60.6	1,668	29.9
S	603	15.2	466	41.2	105	27.1	17	18.1	1,191	21.4
Total	3,958	100.0	1,130	100.0	388	100.0	94	100.0	5,570	100.0
2018 - Municipalities benefited from the increment in the PAB by parliamentary amendments
CW	298	8.6	21	2.1	9	3.0	1	1.5	329	6.8
NE	1,455	42.0	111	11.2	44	14.5	7	10.4	1,617	33.5
N	359	10.4	36	3.6	16	5.3	3	4.5	414	8.6
SE	809	23.3	381	38.6	146	48.2	40	59.7	1,376	28.5
S	544	15.7	439	44.4	88	29.0	16	23.9	1,087	22.5
Total	3,465	100.0	988	100.0	303	100.0	67	100.0	4,823	100.0
2019 - Municipalities benefited from the increment in the PAB by parliamentary amendments
CW	367	10.0	29	2.8	14	3.9	2	2.3	412	8.0
NE	1,554	42.6	117	11.3	49	13.7	11	12.5	1,731	33.7
N	369	10.1	42	4.1	20	5.6	4	4.5	435	8.5
SE	824	22.6	410	39.7	173	48.3	56	63.6	1,463	28.5
S	538	14.7	434	42.1	102	28.5	15	17.0	1,089	21.2
Total	3,652	100.0	1,032	100.0	358	100.0	88	100.0	5,130	100.0

Population size ranges	PAB-Fixo resource allocation groups								Total

	I		II		III		IV

	n	Group (%)	n	Group (%)	n	Group (%)	n	Group (%)	n	Group (%)
2015, 2016, and 2017 – All municipalities (PAB-Fixo)
≤ 5,000	694	26.7	508	24.8	90	12.0	8	4.9	1,300	23.3
5,001–10,000	670	25.7	434	21.2	96	12.8	11	6.7	1,211	21.7
10,001–20,000	755	29.0	508	24.8	121	16.1	8	4.9	1,392	25.0
20,001–50,000	485	18.6	416	20.3	126	16.8	28	17.1	1,055	18.9
50,001–100,000	0	0.0	185	9.0	126	16.8	13	7.9	324	5.8
100,001–500,000	0	0.0	0	0.0	192	25.6	58	35.4	250	4.5
≥ 500,000	0	0.0	0	0.0	0	0.0	38	23.2	38	0.7
Total	2,604	100.0	2,051	100.0	751	100.0	164	100.0	5,570	100.0
2015 – Municipalities benefited from the increment in the PAB by parliamentary amendments
≤ 5,000	36	25.9	22	19.3	4	7.7	0	0.0	62	19.7
5,001–10,000	43	30.9	27	23.7	10	19.2	0	0.0	80	25.5
10,001–20,000	33	23.7	32	28.1	10	19.2	0	0.0	75	23.9
20,001–50,000	27	19.4	26	22.8	10	19.2	3	33.3	66	21.0
50,001–100,000	0	0.0	7	6.1	7	13.5	0	0.0	14	4.5
100,001–500,000	0	0.0	0	0.0	11	21.2	2	22.2	13	4.1
≥ 500,000	0	0.0	0	0.0	0	0.0	4	44.4	4	1.3
Total	139	100.0	114	100.0	52	100.0	9	100.0	314	100.0
2016 – Municipalities benefited from the increment in the PAB by parliamentary amendments
≤ 5,000	221	25.2	151	20.8	32	10.0	0	0.0	404	20.5
5,001–10,000	232	26.5	157	21.7	44	13.7	3	6.1	436	22.1
10,001–20,000	250	28.5	195	26.9	59	18.4	1	2.0	505	25.6
20,001–50,000	174	19.8	161	22.2	55	17.1	10	20.4	400	20.3
50,001–100,000	0	0.0	61	8.4	58	18.1	5	10.2	124	6.3
100,001–500,000	0	0.0	0	0.0	73	22.7	16	32.7	89	4.5
≥ 500,000	0	0.0	0	0.0	0	0.0	14	28.6	14	0.7
Total	877	100.0	725	100.0	321	100.0	49	100.0	1972	100.0
2017 – Municipalities benefited from the increment in the PAB by parliamentary amendments
≤ 5,000	485	29.1	337	24.7	62	12.4	5	5.5	889	24.6
5,001–10,000	454	27.3	289	21.2	72	14.4	7	7.7	822	22.7
10,001–20,000	457	27.4	337	24.7	94	18.8	3	3.3	891	24.6
20,001–50,000	269	16.2	274	20.1	84	16.8	18	19.8	645	17.8
50,001–100,000	0	0.0	126	9.2	84	16.8	7	7.7	217	6.0
100,001–500,000	0	0.0	0	0.0	105	21.0	29	31.9	134	3.7
≥ 500,000	0	0.0	0	0.0	0	0.0	22	24.2	22	0.6
Total	1,665	100.0	1,363	100.0	501	100.0	91	100.0	3,620	100.0
2018 and 2019 – All municipalities (receiving the PAB-Fixo)
≤ 5,000	1,052	26.6	166	14.7	16	4.1	3	3.2	1,237	22.2
5,001–10,000	1,018	25.7	169	15.0	22	5.7	0	0.0	1,209	21.7
10,001–20,000	1,096	27.7	246	21.8	17	4.4	5	5.3	1,364	24.5
20,001–50,000	792	20.0	248	21.9	52	13.4	9	9.6	1,101	19.8
50,001–100,000	0	0.0	301	26.6	43	11.1	6	6.4	350	6.3
100,001–500,000	0	0.0	0	0.0	238	61.3	30	31.9	268	4.8
≥ 500,000	0	0.0	0	0.0	0	0.0	41	43.6	41	0.7
Total	3,958	100.0	1,130	100.0	388	100.0	94	100.0	5,570	100.0
2018 – Municipalities benefited from the increment in the PAB by parliamentary amendments
≤ 5,000	908	26.2	147	14.9	12	4.0	3	4.5	1,070	22.2
5,001–10,000	907	26.2	155	15.7	18	5.9	0	0.0	1,080	22.4
10,001–20,000	963	27.8	229	23.2	16	5.3	3	4.5	1,211	25.1
20,001–50,000	687	19.8	202	20.4	41	13.5	9	13.4	939	19.5
50,001–100,000	0	0.0	255	25.8	35	11.6	4	6.0	294	6.1
100,001–500,000	0	0.0	0	0.0	181	59.7	23	34.3	204	4.2
≥ 500,000	0	0.0	0	0.0	0	0.0	25	37.3	25	0.5
Total	3,465	100.0	988	100.0	303	100.0	67	100.0	4,823	100.0
2019 – Municipalities benefited from the increment in the PAB by parliamentary amendments
≤ 5,000	931	25.5	143	13.9	13	3.6	2	2.3	1,089	21.2
5,001–10,000	935	25.6	149	14.4	17	4.7	0	0.0	1,101	21.5
10,001–20,000	1,042	28.5	225	21.8	16	4.5	4	4.5	1,287	25.1
20,001–50,000	744	20.4	230	22.3	50	14.0	9	10.2	1,033	20.1
50,001–100,000	0	0.0	285	27.6	41	11.5	6	6.8	332	6.5
100,001–500,000	0	0.0	0	0.0	221	61.7	29	33.0	250	4.9
≥ 500,000	0	0.0	0	0.0	0	0.0	38	43.2	38	0.7
Total	3,652	100.0	1,032	100.0	358	100.0	88	100.0	5,130	100.0

Resource Allocation Groups	PAB-Fixo	Increment to the PAB			PAB-Fixo	Increment to the PAB

	2015, 2016, and 2017	2015	2016	2017	2018 and 2019	2018	2019
Total amount in 2020 R$
Group I	1,124,748,593	34,042,736	348,535,796	888,855,288	1,501,737,158	2,806,017,353	3,159,522,314
Group II	1,242,968,275	32,436,990	292,125,244	760,961,497	943,886,451	833,223,227	1,104,026,427
Group III	1,594,723,442	19,670,932	212,915,263	381,464,102	1,317,320,727	509,097,654	888,507,783
Group IV	2,078,489,331	8,908,991	84,636,888	113,825,593	1,745,813,233	190,696,645	424,829,357
Brazil	6,040,929,641	95,059,649	938,213,191	2,145,106,481	5,508,757,569	4,339,034,880	5,576,885,881
Average per capita value in 2020 R$
Group I	35	31	44	61	30	81	80
Group II	34	27	36	50	28	45	46
Group III	31	13	21	30	26	18	23
Group IV	29	6	8	15	25	9	15
Brazil	34	26	36	52	29	69	68
Percentage of municipalities benefited by group (%)
Group I	100	5	34	64	100	88	92
Group II	100	6	35	66	100	87	91
Group III	100	7	43	67	100	78	92
Group IV	100	5	30	55	100	71	94
Brazil	100	6	35	65	100	87	92

Resource allocation groups	Base of comparison 2015				Base of comparison 2018

	PAB-Fixo	Increment to PAB	Z-test		PAB-Fixo	Increment to PAB	Z-test

	2015, 2016, and 2017	Average 2015–2017	X2	p	2018 and 2019	Average 2018–2019	X2	p
Proportion of municipalities
Group I	47	45	0.02	0.88720	71	72	8.86	1.00000
Group II	37	37	0.00	1.00000	20	20	0.00	1.00000
Group III	13	16	0.16	0.68790	7	7	0.00	1.00000
Group IV	3	3	0.00	1.00000	2	2	0.00	1.00000
Total	100	100			100	100
Proportion of resources
Group I	19	38	7.95	0.00481^b	27	61	22.10	0.002591^b
Group II	21	34	3.61	0.05739	17	19	0.03	0.85400
Group III	26	20	0.71	0.40080	24	14	2.63	0.10480
Group IV	34	8	18.84	0.00001^a	32	6	20.30	0.006601^b
Total	100	100			100	100

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[1] Correspondence: Fabiola Sulpino Vieira SEPS 702/902, Edifício Brasília 50 Torre B, 5º andar, Pétala C 70.390-025 Brasília, DF, Brasil E-mail: fabiola.vieira@ipea.gov.br