Fiscal Federalism and Inequalities in the Brazilian Public Healthcare Sector

Abstract: The "Single Health System" (Sistema Único de Saúde - SUS) is the main public healthcare system in Brazil, serving around 47 million patients per year and performing nearly 80% of all high-complexity procedures in the country. In this work, we study the potential allocative impacts of the distribution of SUS resources among Brazilian regions and states. We built financial concentration indices (CI) related to the evolution of specific transfers from SUS (provision of financial funds) and infant mortality (public healthcare sector performance) in the pre-pandemic period. The analysis was performed both in aggregate and per capita terms for Brazilian states and regions. We also compute Shapley’s Solution (SS) for a cooperative scarce resource allocation game in a financial resource bankruptcy problem.

Keywords: Healthcare, Inequality, Concentration Index, Bankruptcy Problem, Shapley Value

JEL Classification Number: I11, I14, H51