Sustainability of public health in diadema, 2000 - 2011: a picture of SUS building limits

Abstract

Introduction: between 2000 to 2011, Diadema paulista municipality has faced many obstacles in health management, struggling to ensure the sustainability of its health system. Objective: to contribute to the discussion of the Unified Health System (SUS) and its foreseable turbulent future, based on the analysis of the municipal point of view, identifying the limits of its building in Diadema. Methods: Diadema is characterized as one of the first municipalities that adhered to the principles of the SUS, since its implementation, allowing an analysis as a case study in view of the system's sustainability at the local level. The term sustainability used was addressed in two dimensions: the structure of this system and its process. Results: in SUS implementation period, Diadema stood out by increasing investment in health, reaching an average allocation of about 30% of its tax revenues, including constitutional transfers. Results diagnosed by observing the structure of dimensions and the process indicate that the sustainability of the municipal health system is threatened, as the significant expansion of the range of services and health actions was not followed by sufficient resources to its health maintenance. Conclusions: the existence of obstacles justified and formed the basis for the diagnosis of the main limits on SUS conformation, in health policy and management of resources, funding and budgetary impacts.