A eficiência do gasto público como viabilizadora do novo regime fiscal: uma aplicação para as internações do Sistema Único de Saúde no Brasil entre 2008 e 2017
Carregando...
Data
2019-03-28
Autores
Bronzim, Arthur Henrique Santos
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Após um longo período de baixo crescimento econômico e uma rápida deterioração do quadro fiscal brasileiro, um Novo Regime Fiscal (NRF) foi apresentado como medida econômica capaz de solucionar os desequilíbrios fiscais no médio e longo prazos e, sobretudo, colocar a dívida pública bruta do Governo geral em condições de solvabilidade. Esse NRF, institucionalizado no âmbito da União e dos órgãos federais com autonomia orçamentária, tem como arcabouço teórico de sustentação os elementos da Contração Fiscal Expansionista. Partindo de um diagnóstico que aponta que o desequilíbrio fiscal brasileiro se encontra nos gastos não financeiros, cria-se um desenho institucional dos gastos do governo, com base no estabelecimento de um teto para os gastos primários. Entretanto, dentre os gastos primários que estão sob o teto do NRF, há rubricas que, além de estarem protegidas constitucionalmente de qualquer alteração, mantem-se em alta. Em outras palavras, abaixo do teto imposto há gastos que se mantem crescentes e não podem ser alterados por força de lei que os protege. Esse panorama gera desconfiança quanto a capacidade do NRF em cumprir sua vida útil proposta, pois serão necessárias constantes diminuições nos gastos discricionários para compensar o aumento dos obrigatórios, visando não estourar o teto – sem qualquer garantia de sucesso nessa tarefa. Diante desse quadro, o objetivo principal desse trabalho é testar a hipótese de que um aumento na eficiência dos gastos públicos pode ser capaz de aliviar tal pressão no teto dos gastos mediante mapeamento de recursos que podem ser economizados, dando sobrevida ao NRF sem que sejam negligenciadas questões quanto a perda de qualidade/quantidade dos serviços públicos prestados. Para tal, elegeu-se como estudo de caso o setor da saúde uma vez que esse tem grande importância em qualquer espaço-tempo a qual se insere, além de ser extremamente afetado pelas regras do Novo Regime Fiscal. Dessa forma, buscou-se, na revisão literária da eficiência do gasto público em saúde e na aplicação do método conhecido como Data Envelopment Analysis (DEA), a identificação de espaços para aumento da eficiência dos gastos em saúde. Após 12 modelos com diferentes abordagens e níveis de aprofundamentos, apresenta-se resultados que confirmam a hipótese sugerida, isto é, a economia de recursos gerada com aumento da eficiência é altamente relevante. Além disso, os dados mostram que a eficiência possui uma segunda faceta relevante: melhorar resultados mantendo os recursos utilizados constantes. Essa aplicação se faz extremamente relevante pois, em setores os quais o investimento total se faz muito próximo de um piso estabelecido em lei, como no caso da saúde, é possível atingir a redução máxima de custos permitida e ainda sobrar ineficiência a ser mitigada com melhora de resultados. Sendo assim, o cenário perfeito de conseguir economia de recursos sem qualquer piora nos resultados não se apresenta utópico. Esses resultados, apesar de focados no setor da saúde, podem ser extrapolados para o setor público de maneira geral – os devidos cuidados – uma vez que a ampla limitação legal para redução dos gastos nesse recorte generalizado também está presente. Isso torna algumas afirmações específicas da saúde bastante aplicáveis para os gastos primários totais.
After a long period of low economic growth and a rapid deterioration of the Brazilian fiscal framework, a “Novo Regime Fiscal” (NRF) was presented as an economic reaction plan capable of solving Brazilian public accounts problem in medium and long term and, above all, put the gross public debt General government in solvency. The NRF, institutionalized in the scope of the Union and the federal agencies with budgetary autonomy, has elements of the Fiscal Expansionist as its theoretical foundation. Based on a diagnosis that indicates that the Brazilian fiscal problem is in non-financial expenditures, an institutional design of government spending is created, based on the establishment of a maximum limit (roof) for primary expenditures. However, among the primary expenditures under this limit, there are items that keep growing up and this trend can’t be changed because they are constitutionally protected. This scenario generates mistrust regarding the NRF's ability to meet its proposed useful life, because, in order to fit all the spending under this roof, the government must constantly decrease discretionary spending to compensate the increase in the mandatory ones, - with no guarantee of success in this task. The main objective of this paper is to test the hypothesis that an increase in the efficiency of public expenditures may be able to alleviate such pressure on the ceiling of expenditures by mapping resources that can be saved, giving an extra life to NRF without being neglected with loss of quality/quantity of public services provided. For this purpose, the health sector was chosen as a case since it has great importance in any space-time that is inserted and it’s extremely affected by the rules of the New Fiscal Regime. Thus, in the literary review of the efficiency of public spending on health and in the application of the method known as Data Envelopment Analysis (DEA), the identification of spaces to increase the efficiency of health spending was sought. After 11 models with different approaches and levels of deepening, is presented some results that confirm the hypothesis suggested, that is, the resource saving generated with increased efficiency is highly relevant. In addition, the data show that efficiency has a second important aspect: improving results while keeping the resources used constant. This application becomes extremely relevant because, in sectors where total investment is very close to a floor established by law, as in the case of health sector, it is possible to achieve the maximum allowable cost reduction and still have inefficiency to be mitigated with improvement of results. Thus, the perfect scenario of saving resources without any worsening results is not utopian. These results, although focused on the health sector, can be extrapolated to the public sector in general - due care - since the broad legal limitation for reducing spending in this generalized cut is also present. This makes some specific health claims quite applicable to total primary expenditures.
After a long period of low economic growth and a rapid deterioration of the Brazilian fiscal framework, a “Novo Regime Fiscal” (NRF) was presented as an economic reaction plan capable of solving Brazilian public accounts problem in medium and long term and, above all, put the gross public debt General government in solvency. The NRF, institutionalized in the scope of the Union and the federal agencies with budgetary autonomy, has elements of the Fiscal Expansionist as its theoretical foundation. Based on a diagnosis that indicates that the Brazilian fiscal problem is in non-financial expenditures, an institutional design of government spending is created, based on the establishment of a maximum limit (roof) for primary expenditures. However, among the primary expenditures under this limit, there are items that keep growing up and this trend can’t be changed because they are constitutionally protected. This scenario generates mistrust regarding the NRF's ability to meet its proposed useful life, because, in order to fit all the spending under this roof, the government must constantly decrease discretionary spending to compensate the increase in the mandatory ones, - with no guarantee of success in this task. The main objective of this paper is to test the hypothesis that an increase in the efficiency of public expenditures may be able to alleviate such pressure on the ceiling of expenditures by mapping resources that can be saved, giving an extra life to NRF without being neglected with loss of quality/quantity of public services provided. For this purpose, the health sector was chosen as a case since it has great importance in any space-time that is inserted and it’s extremely affected by the rules of the New Fiscal Regime. Thus, in the literary review of the efficiency of public spending on health and in the application of the method known as Data Envelopment Analysis (DEA), the identification of spaces to increase the efficiency of health spending was sought. After 11 models with different approaches and levels of deepening, is presented some results that confirm the hypothesis suggested, that is, the resource saving generated with increased efficiency is highly relevant. In addition, the data show that efficiency has a second important aspect: improving results while keeping the resources used constant. This application becomes extremely relevant because, in sectors where total investment is very close to a floor established by law, as in the case of health sector, it is possible to achieve the maximum allowable cost reduction and still have inefficiency to be mitigated with improvement of results. Thus, the perfect scenario of saving resources without any worsening results is not utopian. These results, although focused on the health sector, can be extrapolated to the public sector in general - due care - since the broad legal limitation for reducing spending in this generalized cut is also present. This makes some specific health claims quite applicable to total primary expenditures.
Descrição
Palavras-chave
Eficiência do Gasto Público, Economia do Setor Público, Novo Regime Fiscal, Economia da Saúde, Efficiency of Public Spending, Economy of the Public Sector, New Fiscal Regime, Health Economics