Titre:	Análise do financiamento para aquisição de medicamentos na Atenção Primária : iniquidades entre os municípios brasileiros
Auteur(s):	Silva, Wendell Rodrigues Oliveira da
Orientador(es)::	Contezini, Silvana Nair Leite
Assunto::	Medicamentos Sistema Único de Saúde (Brasil) Ministério da Saúde Investimento público
Date de publication:	12-nov-2024
Data de defesa::	26-fév-2024
Référence bibliographique:	SILVA, Wendell Rodrigues Oliveira da. Análise do financiamento para aquisição de medicamentos na Atenção Primária: iniquidades entre os municípios brasileiros. 2024. 145 f., il. Tese (Doutorado em Ciências Farmacêuticas) — Universidade de Brasília, Brasília, 2024.
Abstract:	Financing and investment issues have been part of the research agendas on the Unified Health System (SUS). Although it is recognized that there are resource management problems, it is argued that the system that aims to be “universal” and “integral” operates with underfunding. Financing is also an essential factor in the availability of medicines, a key element in a resolute health system. That said, this study aimed to analyze public investments made by federated entities in medicines and identify potential inequalities in the application of these resources that could have impacts on the supply of medicines through the Unified Health System (SUS). The thesis is presented in 03 chapters. In chapter 01 - Threatened equity: Regional asymmetries in investments in medicines in Brazil, an analysis of investments in health and medicines by the Union, states and municipalities between 2010 and 2019 was carried out, aiming to identify regional differences in the application of these resources and it was observed that although per capita investments in health were higher by municipalities (R$ 926.54), when it comes to medicines, this per capita investment was higher by the Union (R$ 61.89). It was also identified that municipalities in the Northeast and North regions invest less in purchasing medicines when compared to the national average (R$40.41), R$24.20 and R$23.58 respectively. By exploring the percentage of investment in medicines compared to the total investment in health among entities, it was possible to verify that states and municipalities have been decreasing their percentages of investment in medicines, highlighting the greatest reduction by states, where this decrease was 72 .8% during the evaluated period. Chapter 02 presents an analysis of the resources for purchasing Primary Care medicines among the responsibilities of federated entities since 2016, highlighting municipal characteristics. This is a retrospective study, in which the evolution of the values of CBAF counterparts by entities was identified and compared. The amounts spent on medicines by the municipalities were higher than the counterparts from the Ministry of Health (MS) or MS+Estado in the period analyzed. The average percentage of transfers of federal resources and municipal expenditures vary depending on the Brazilian region. The average per capita value invested in medicines by municipalities increased between 2016 and 2020, with the impact being greater for municipalities with lower MHDI. The Popular Pharmacy Program mainly affects municipalities with the largest population sizes and highest MHDI, and is therefore not sufficient to address the inequities highlighted. It is concluded, from this chapter, that there has been an increase in inequalities in the capacity of municipalities to ensure access to medicines, especially among the most vulnerable municipalities, accumulating more risks of injuries and deaths from diseases sensitive to Primary Care. And in chapter 03, with the proposal of the RE indicator, which measures the quality of the price charged in the acquisition of medicines, the prices charged in the acquisition of the most used medicines in Primary Care in Brazilian municipalities were analyzed in the years 2016, 2018 and 2020 using data collected in the National Database of Pharmaceutical Assistance Actions and Services in the SUS (BNAFAR). This study also showed the importance of the practice of combined purchasing in drug prices, in addition to detecting differences in drug prices in relation to analyzes by population strata, by region and by MHDI. It is concluded that there is a regional asymmetry in investments in health and medicines in Brazil, in addition to the different evolution of these investments in the period analyzed in each chapter, with the most vulnerable regions being those that invested least. The increase in inequalities in the capacity of municipalities to ensure access to medicines was shown, especially among the most vulnerable municipalities, accumulating even more risks of injuries and deaths from diseases sensitive to primary care. The relevance of the SUS to promote access to medicines is well-known, however it is suggested that governments pay greater attention to investing in medicines to serve the population, as barriers to access to medicines can have a negative result on adherence to treatment, and achieving universal health coverage for medicines reduces household expenditures on healthcare costs, healthcare litigation, outpatient care, hospitalization, and mortality. It is also suggested that public policies be developed that reduce asymmetries in the evolution of investments in health and medicines by all entities and that contribute to promoting equity in investments in health and medicines throughout the country.”
metadata.dc.description.unidade:	Faculdade de Ciências da Saúde (FS) Departamento de Farmácia (FS FAR)
Description:	Tese (doutorado) — Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências Farmacêuticas, 2024.
metadata.dc.description.ppg:	Programa de Pós-Graduação em Ciências Farmacêuticas
Licença::	A concessão da licença deste item refere-se ao termo de autorização impresso assinado pelo autor com as seguintes condições: Na qualidade de titular dos direitos de autor da publicação, autorizo a Universidade de Brasília e o IBICT a disponibilizar por meio dos sites www.unb.br, www.ibict.br, www.ndltd.org sem ressarcimento dos direitos autorais, de acordo com a Lei nº 9610/98, o texto integral da obra supracitada, conforme permissões assinaladas, para fins de leitura, impressão e/ou download, a título de divulgação da produção científica brasileira, a partir desta data.
Collection(s) :	Teses, dissertações e produtos pós-doutorado

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