Unconditional transfers goes to health? Evidence from Brazilian municipalities

This study assesses the impact of unconditional transfer resources on the health indicators of Brazilian municipalities. This transfer refers to the Participation Fund of Municipalities (FPM) where at least 15% of its value should be spent on public health. Based on a discontinuity of the rules of transfers, we explore Regression Discontinuous Design for the years 2002 to 2010, and find: (i) no significant effect of FPM on mortality reduction; (ii) a robust and significant reduction in morbidity, treated municipalities – on the right side of thresholds – on average have a per capita rate of morbidity 0.00821% lower than those on the left side of the cutoff points; (iii) the mechanisms through which a reduction on morbidity could be operated would be due to estimated increases in preventive measures such as consultations and medical and nurses visits, these were bigger for the treated group in, respectively, 0.32%, 0.038% and 0.039%.

Spatial spillovers and political coordination in public health provision

We estimate the impact of the main unconditional federal grant (Fundo de Participaçãodos Municípios - FPM) to Brazilian municipalities as well as its spillover from the neighboring cities on local health outcomes. We consider data from 2002 to 2007 (Brollo et al, 2013) and explore the FPM distribution rule according to population brackets to apply a fuzzy Regression Discontinuity Design (RDD) using cities near the thresholds. In elasticity terms, we nd a reduction on infant mortality rate (-0.18) and on morbidity rate (- 0.41), except in the largest cities of our sample. We also nd an increase on the access to the main program of visiting the vulnerable families, the Family Health Program (Programa Sa ude da Família - PSF). The e ects are stronger for the smallest cities of our sample and we nd increase: (i) On the percentage of residents enrolled in the program (0.36), (ii) On the per capita number of PSF visits (1.59), and (iii) On the per capita number of PSF visits with a doctor (1.8) and nurse (2). After we control for the FPM spillover using neighboring cities near diferent thresholds, our results show that the reduction in morbidity and mortality is largely due to the spillover e ect, but there are negative spillover on preventive actions, as PSF doctors visits and vaccination. Finally, the negative spillover e ect on health resources may be due free riding or political coordination problems, as in the case of the number of hospital beds, but also due to to competition for health professionals, as in the case of number of doctors (-0.35 and -0.87, respectively), specially general practitioners and surgeons (-1.84 and -2.45).