Under the prism of equity: federal financing of Unified Health System in Bahia state, Brazil

Abstract

This article aims to analyze the distribution of federal funding for the municipalities of the state of Bahia, in 2010, from the perspective of equity. The methodology used Brazil's "National Health Care Accounts" model to identify the flow of funds; Municipal Human Development Index (MHDI) as a proxy for health care needs; and health care supply indicators by macro-regions. Federal transfers totaled R$ 2 billion, R$ 146.36 per capita, 20% of these funds being destined to the 219 municipalities with the lowest MHDI indices. The 37 municipalities with the best MHDI indices received 60% of the funds; that is, over R$ 1.23 billion. 30% of the funds (R$ 615.45 million) were found to be destined to 40% of the state population spread through 348 municipalities, and over R$ 1 billion was also transferred to 40% of a population distributed through only 17 municipalities. The most populous region in the nine macro-regions, which also had the highest installed capacity, received 32.81% of the funds alone. The macro-region with the highest number of health care teams per inhabitant had the second best MHDI. A great concentration of funds was found to be destined to few municipalities with large populations and the highest MHDI indices, but smaller regions with higher health care needs received a low volume of funds.