SUS financing and Covid-19: history, federative participation, and responses to the pandemic

Abstract

This essay discusses financial resources for Brazil’s Unified Health System (SUS) in a historical and future perspective, considering the health and economic challenges imposed by the Covid-19 pandemic. As always and more than ever, we need to discuss SUS financing. This is aggravated in intensity by the context of chronic economic recession that the country has been experiencing since 2014 and accentuated in urgency by the deep depression in the post-Covid. The pandemic happens in a context of diminishing federal participation in SUS financing, little space for states to expand their sources of financing and several problems of coordination between federal entities. We argue that facing the pandemic necessarily involves an expansion of resources for financing SUS and it has a great dependence on the performance of the federal government. However, even with the urgency that the pandemic demanded, the release of new resources approved by the National Congress for public health system has been quite slow. In this period, the states have prioritized contracting services from the private sector to expand the offer of intensive care. We conclude that the prospects do not point to prioritizing the SUS and expanding its funding in the post-pandemic period.