When to trying harder and not just spending more makes the whole difference: the case of public health in municipalities of São Paulo

Abstract

The purpose of this article is to investigate the effectiveness of current the model of public spending in health in Brazil at the municipal level, using data from Sao Paulo, the richest state in the country. After a brief introduction, discussing the development of the SUS and the Brazilian accounting system, we go into further detail about how public spending is done in the sector. In short, we seek to assess whether an increase in spending on health as well as the effort of the public manager, measured by its ability to expand the tax base, improve the quality of public health, measured with the infant mortality rate. The results show that the commitment of the public administrator is a relevant factor and that increases in total spending does not lead to better performance.