O financiamento da Atenção Primária à Saúde – Programa Previne Brasil: uma análise sobre os municípios da região noroeste fluminense

Abstract

The financing of Primary Health Care funding was established in 1996 with the creation of the Primary Health Care Floor, containing a fixed and a variable part. At the end of 2019, the Ministry of Health instituted a new funding model for PHC, called the Previne Brasil Program, made up of components: Weighted Capitation, Payment for Performance and Incentive for Strategic Actions. This study aims to analyze the financing of Primary Health Care in the 14 municipalities of the Northwest Fluminense region of the State of Rio de Janeiro, from 1999 to 2023, and its specific objectives are to identify the amounts of financial transfers, analyze and discuss the results achieved by the municipalities in terms of population registration, performance indicators and adherence to strategic actions and programs between 2019 and 2023, before and after the institution of the new financing. The methodology used is that of a longitudinal study of analysis using descriptive statistics of trends in a time series, with the combination of different research methods, making use of bibliographic and documentary research and secondary data collection on the public platforms of e-Gestor and the National Health Fund. Statistical analysis was used to process and code the data, according to the results observed for each component of Previne Brasil and overall funding. The results showed that the overall financing of PHC exhibited a growth trend in resources received between 1999 and 2023, with some fluctuations in certain periods. The global funding for PHC saw a significant increase, especially with the introduction of Previne Brasil in 2020. For the Weighted Capitation component, there was a significant increase in the registration of the population of all municipalities in the region, including the vulnerable population. In the Performance Indicators component, the data showed a gradual improvement in the indicators, although the results were well below the targets set by the program. In the Strategic Actions component, there was an increase in adherence to strategic programs, driven mainly by the need to strengthen the health system during the pandemic. It is important to note that funding for these actions varied significantly between municipalities, depending on local capacity to implement and adapt to the Ministry of Health's requirements. Not all municipalities were able to take full advantage of these incentives, while some managed to expand their services more efficiently. Previne Brasil was revoked in April 2024, so with a very short duration, it is not possible to expand the discussion on whether or not its implementation has contributed to improvements in the financial and management fields of PHC. We observed that in 2023, some municipalities were already adapted to its rules and others were trying to adapt.