Governança do financiamento da saúdeuma análise comparativa entre Brasil, Uruguai e Chile

Resumo

This dissertation examines the governance of health financing in three Latin American countries, Brazil, Uruguay, and Chile, through a comparative analysis of their national health funds and the institutional mechanisms that govern revenue collection, resource allocation, and financial oversight. In the Brazilian case, the study explores the normative evolution of the Unified Health System (SUS), the structure and functions of the National Health Fund (FNS), and the modalities of intergovernmental transfers. Particular attention is given to the role of constitutional provisions, such as Constitutional Amendment No. 29/2000 and Complementary Law No. 141/2012, which underscore the centrality of the FNS in the decentralized execution of the federal health budget. The analysis of Uruguay and Chile highlights contrasting institutional arrangements. Uruguay operates an integrated system characterized by strong state leadership and redistributive mechanisms within FONASA, notably through risk-adjusted capitation and performance-based goals. Chile, by contrast, maintains a dual and segmented model, in which the public insurance system (FONASA) coexists with private insurers (ISAPRES), generating access inequalities and institutional fragmentation. The findings underscore how institutional design shapes the equity, sustainability, and efficiency of health systems. By elucidating these dynamics, the dissertation offers critical insights for the refinement of Brazil’s health financing framework and contributes to broader debates on public health governance in decentralized contexts.

Ficha do documento

Tipo

Dissertação

Ano

2025

Instituição

Fundação Getulio Vargas

Fonte

Repositório da FGV

Idioma

Português

Acesso

Acesso aberto

Identificador

oai:repositorio.fgv.br:10438/38039

Temas

Administração PúblicaGovernançaSaúde

Palavras-chave

Financiamento da saúdeSUSFundo Nacional de SaúdeGovernança multívelFONASAHealth financingNational health fundMultilevel governanceAdministração públicaSaúde pública - América Latina - FinanciamentoSistema Único de Saúde (Brasil)Fundo Nacional de Saúde (Brasil)Descentralização na administração pública