The institutionalization of health economics within the Ministry of Health in Brazil: A 2003-2023 analysis

Abstract

Health economics has established itself as a strategic function in the Brazilian National Health System (SUS), contributing to greater equity, transparency, and efficiency in the allocation of public resources. This study analyzes the institutional trajectory of the Department of Health Economics and Development (DESID) of the Ministry of Health from 2003 to 2023, highlighting its key milestones, strategic axes, and persistent challenges. The research, from a historical-social perspective, was based on a documentary and content analysis of 126 official records available in the Virtual Health Library (VHL)-Health Economics section and in DESID’s institutional collection, covering the period from 1988 to 2024. The results show that the department’s activities were structured around three central axes: management tools, monitoring and evaluation, and transparency and equity. These were operationalized in seven dimensions: financing regulation; management tools development; technical standardization and decentralization; budgetary control and efficiency; economic and technological evaluation; information production; and accountability and social control. Over two decades, DESID has promoted systems such as the Public Health Budget Information System and the Health Price Bank, produced manuals, glossaries, and bulletins, and strengthened fiscal transparency and evidence-based decision-making. However, major gaps remain, including the absence of systematic impact assessments, weak economic regulation of the private sector, and limited focus on vulnerable populations. It is concluded that, despite advances in institutionalizing health economics as a strategic technical area in the SUS, there remains an urgent need for a national health economics policy to ensure equity, sustainability, and efficiency in public health financing in Brazil.

Keywords

Health economics / Brazilian National Health System / Public funding / Transparency / Governance / Brazil

Funding

This study was funded by the Brazilian Ministry of Health through the “Health Economics” Project, executed by the Laboratory for Technological Innovation in Health at the Federal University of Rio Grande do Norte (TED 52/2022-MS).

Conflict of interest

The authors declare they have no competing interests.

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