Título:	Os impasses no financiamento do Sistema Único de Saúde na era da mundialização do capital
Autor(es):	Couri, Joseane Rotatori
E-mail do autor:	joseane.couri@gmail.com
Orientador(es):	Salvador, Evilásio da Silva
Assunto:	Saúde Financiamento Estado Fundo público
Data de publicação:	28-Out-2021
Data de defesa:	30-Jul-2021
Referência:	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:	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.
Unidade Acadêmica:	Instituto de Ciências Humanas (ICH) Departamento de Serviço Social (ICH SER)
Informações adicionais:	Tese (doutorado)—Universidade de Brasília, Instituto de Ciências Humanas, Departamento de Serviço Social, Programa de Pós-Graduação em Política Social, 2021.
Programa de pós-graduação:	Programa de Pós-Graduação em Política Social
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