Brasília – A new study from the Institute for Applied Economic Research (Ipea) reveals that parliamentary amendments for healthcare—funding the primary and specialized care within Brazil’s Unified Health System (SUS)—have grown substantially between 2019 and 2024, but continue to display significant regional disparities and transparency limitations..

During this period, the spending limits set by the Ministry of Health for such transfers rose markedly: increases of 147% for state-level specialized care and 231% for municipal-level specialized care. Actual payments also surged—79% and 120% respectively for specialized services, and 51% for primary care funding.

Yet distribution remains unequal. In 2024, municipalities in Alagoas received R$ 186 per capita for primary care, followed by Piauí (R$ 157) and Roraima (R$ 150), while the Federal District received only R$ 0.80 per capita. For specialized care, the highest per capita transfers were recorded in Amapá (R$ 262), Roraima (R$ 163), and Alagoas (R$ 161)—contrasting sharply with Santa Catarina, which received just R$ 39.60 per person.

The study also highlights that a significant share of these amendments benefits private non-profit organizations—34.1% of state transfers and 28.1% of municipal ones—without providing transparent data on final recipients, thus impeding social control and the assessment of impact.

Furthermore, a category of resources initially labeled as “relator’s amendments” (emendas de relator)—considered unconstitutional by the Supreme Federal Court—have been reclassified as discretionary spending. Yet transparency remains lacking, as beneficiaries are still not detailed in public databases such as SIOP or SIGA Brasil.

This opaque and unequal allocation of funds risks undermining local planning, creating dependency on volatile, politically motivated resources to finance essential health services—calling into question the sustainability and equity of SUS funding.

Source: Ipea

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