Expenditure and revenues of funding in Brazilian municipalities from 2003 to 2018

Objective: To identify expenditures on primary and hospital care and revenues of health financing in Brazilian municipalities from 2003 to 2018 Methodology: The available data from 5,561 municipalities were systematized by population size and geographic region in Tables and Figures using Microsoft Excel and STATA Software. Results: There is evidences that the Brazilian municipalities made expenditures in the amount of 1.8 trillion of reais in the period from 2003 to 2018, with larger amounts reached by the municipalities of the Southeast and South Regions; and smaller for the Northeast and North. The main source of these funds is their own collection, which includes mandatory legal transfers from the Union and the states. Direct Union transfers to health policies in municipalities are the second largest source of these resources. These rates had a significant increase in the period between 2003 and 2014, with a significant decrease for 2015 and 2016 and a slight recovery in 2017 and 2018. The results were also observed in the municipalities of the Northeast and North with greater dependence on federal resources. Study Contributions: The paper provides clear evidence that small and large municipally managed health systems increase the average health expenditure per inhabitant from 2003 to 2018, with primary care in the smallest municipalities and hospital care in the largest municipalities. This analysis contributes to the discussion of health financing in Brazilian municipalities, a relevant part of the complex consolidated institutional arrangement for public health following the 1988 Constitution of the Federative Republic of Brazil, as well as make questions on the model of public health hospital centralization in Brazil.