O piso e o teto: impactos do arcabouço fiscal para o financiamento da Saúde

O piso e o teto: impactos do arcabouço fiscal para o financiamento da Saúde

Já leu
Foto: Lincoln Xavier/CEE-Fiocruz

Os economistas Pedro Rossi e Grazielle David, do Instituto de Economia da Unicamp, apresentaram, na oficina CEIS 4.0 do CEE-Fiocruz, o estudo O piso e o teto – impactos do novo arcabouço fiscal para o financiamento da Saúde, tema que está “na ordem do dia e no debate público e editoriais dos principais jornais”, conforme destacou Pedro. Para ele, uma das “coisas mais interessantes” observadas no governo Lula está no Ministério da Saúde. “E me sinto parte desse processo”, considerou, ressaltando que o estudo realizado se relaciona ao Sistema Único de Saúde e ao Complexo Econômico-Industrial da Saúde (CEIS), mas “transborda de certa maneira o Ministério da Saúde”.  

O estudo buscou mapear a estratégia do CEIS no orçamento federal, público, primeiro, no Ministério da Saúde e, em seguida, nos demais ministérios; discutir o teto e o piso da Saúde, encontrando aí “uma incompatibilidade”; e apresentar cenários com regras fiscais alternativas.  

Em sua exposição, Pedro Rossi observou que o arcabouço fiscal, hoje, não limita o crescimento e o financiamento da Saúde, porque retoma os velhos pisos, constitucionais, anteriores ao teto de gastos instituído pelo governo Temer, e possibilita assim um crescimento “de forma razoável”, como definiu. Aqueles pisos possibilitam que o gasto mínimo com ações e serviços públicos de saúde cresçam conforme cresce o PIB, conforme a arrecadação. Se a receita cresce 10%, o gasto cresce 10%. Assim, em um contexto de crescimento da economia, não impede o aumento do gasto com saúde, fundamental tanto para a oferta de serviços, quanto para a estratégia de investimento que o Complexo Econômico-Industrial da Saúde demanda e necessita”.

De acordo com Pedro, o problema não está aí, mas na contradição observada entre esse piso constitucional indexado à receita e o fato de o novo arcabouço instituir uma faixa de crescimento para o gasto primário total, entre 0,6% e 2,5%. “Nosso estudo detecta que há uma incompatibilidade entre esse crescimento do gasto com saúde e as regras instituídas pelo novo arcabouço, que é muito rígido e faz com que o gasto público em geral cresça no máximo 2,5%. Se o gasto com saúde crescer mais do que isso, vai provocar um efeito achatamento nos outros gastos”.

Ele alertou para o caminho que vem tomando o debate público a respeito, quanto à necessidade de mudança no piso constitucional. “Nós defendemos que é necessário manter esse piso constitucional e não modificá-lo para caber no novo arcabouço. Se o arcabouço não permite que o gasto com saúde cresça conforme a receita, o problema está no arcabouço e não no piso”, considerou. “Precisamos ampliar o financiamento da saúde, ampliar o CEIS, e, para isso, é necessário investimento público, gasto público. Esse constrangimento que se coloca a partir de uma visão macro, tecnocrata, de que não se pode crescer mais do que isso ou aquilo, não está adequado às necessidades que o Brasil tem no campo da saúde”, apontou.

Grazielle David apresentou dados relativos ao orçamento do Ministério da Saúde, cujo total está em R$ 217,7 bilhões, passando a R$ 207,7 (assistência hospitalar e ambulatorial e atenção básica; despesas correntes; investimentos e gastos com pessoal), se retiradas do montante as funções não diretamente ligadas à Saúde, como Previdência, por exemplo. Embora, todas as ações e serviços de saúde integrem, de certa forma, o CEIS, destacou Grazielle, há um programa específico para o Complexo, voltado à inovação, com dotação orçamentária total de R$ 5,7 bilhões (R$ 4 bilhões no Ministério da Saúde e R$ 1,7 bilhão nos demais ministérios).

Para analisar o impacto do teto de gastos na Saúde e no CEIS, Grazielle apresentou, ainda, os percentuais do orçamento destinados às ações e serviços, os referentes à natureza das despesas (despesas correntes e gastos com pessoal) e os tipos de despesas, obrigatórias e discricionárias (não obrigatórias). “Essa classificação é importante, porque, se houver alteração do piso, os cortes se darão em primeiro lugar no que é estratégico e discricionário”, advertiu.

No mapeamento realizado do CEIS no orçamento da União, a constatação a que chegaram os pesquisadores é que 99% desse orçamento dependem do piso e apenas 1%, de outros ministérios. “Constatamos algo cada vez mais óbvio: o crescimento de Educação e da Saúde é inconsistente com o regime fiscal e mostramos que o arcabouço fiscal vai trazer riscos para o fortalecimento do CEIS. O problema não é o crescimento das despesas de saúde, mas o regime fiscal”, reafirmou Pedro. “Essa demanda de estudo que nos foi feita está na ordem do dia e é fundamental para o debate”.

Para os pesquisadores, há uma escolha a ser feita: ou se continua com o regime fiscal ou se muda o piso de saúde e de educação. “Corremos o risco de conduzir uma agenda que se inicia com o golpe de 2016, com a Ponte paro o Futuro; fazer reformas que desindexam, desindexam, e dar sequência a uma agenda que não é a nossa. Por isso, defendemos a revisão do arcabouço fiscal e não dos gastos com saúde e educação”.
 

Acesse as exposições dos pesquisadores na oficina
Oficina do CEE-Fiocruz discute o fortalecimento do Complexo da Saúde e do SUS em meio às transformações sociais, econômicas e tecnológicas

O piso e o teto: impactos do arcabouço fiscal para o financiamento da Saúde

Transformações tecnológicas na Saúde e no CEIS

Empregos no CEIS: potenciais e desafios

EUA: Sistema de inovações bem-sucedido e sistema de saúde caro, com baixo acesso da população

Índia: paralelos com o Brasil, incentivo à medicina tradicional, valorização da saúde digital e incentivo à pesquisa e à produção

China: articulação bem-sucedida entre acesso à saúde e desenvolvimento produtivo

Reino Unido:

Mercosul: realidades diversas, desafios em comum

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