The financing primary care in Brazil: a balance of two decades (2000-2020)

Abstract

This article analyzes the primary healthcare financing in Brazil between 2000 and 2020. We conducted an integrative review of the scientific productions available in the electronic scientific databases BVS, Scielo, and MEDLINE in December 2020. After including articles undertaken in Brazil, with free access, and excluding duplicates and non-scientific texts, ten articles were selected. Those articles were submitted to Thematic Content Analysis and organized into two categories (1) “Municipal differences in the financing of Primary Care” and (2) “Tripartite Financing of Primary Care”. The results of this review pointed out several inequalities in the financing of primary healthcare. Although federal participation in the budget has grown during the analyzed period, the transfers occurred due to incentives for the adoption of federal programs that did not reach the municipalities homogeneously. Compared to the South and Southeast, small municipalities in the North and Northeast regions had greater dependence on federal transfers. In addition, there was lower state participation in the overall financing in the North and Northeast regions. The main limitation of our review was not including studies published since 2021 analyzing the impacts of recent policies that aggravated the underfunding of primary healthcare in Brazil, which could have potentially worsened the results presented in this study and put primary healthcare quality and preservation even more at risk.