Saiba como a PEC 241 vai mudar os investimentos públicos em saúde

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susAprovada em primeiro turno pela Câmara dos Deputados na última segunda-feira (10), a Proposta de Emenda a Constituição (PEC) 241 vem despertando debates entre as entidades do setor da saúde, que temem uma redução nos investimentos. De acordo com os cálculos e a avaliação do consultor Mário Luís de Souza, da Consultoria de Orçamento e Fiscalização Financeira da Câmara dos Deputados, A PEC 241 só traria vantagens para a saúde se a economia ficasse estagnada ou em declínio. Para ele, se o país voltar a crescer, a regra será desvantajosa em comparação à norma vigente.

“Se a receita do país só aumentar o percentual equivalente ao índice da inflação, não vai ter diferença entre o piso da regra vigente e o da PEC 241. Porém, se o país voltar a crescer, o que é a tendência, a regra vigente é mais interessante, já que com ela, se cresce a receita, cresce a fatia da saúde proporcionalmente”, detalhou o consultor. Já o Ministério da Saúde defende que a nova regra evitará a redução do piso de gastos na área de saúde em momentos de contração da economia e de queda da receita.

Batizada de Novo Regime Fiscal pelo governo, a PEC 241 limita durante 20 anos o ritmo de crescimento dos gastos da União à taxa de inflação medida pelo Índice Nacional de Preços ao Consumidor Amplo (IPCA). Isso significa que para aumentar o orçamento de uma pasta, o governo tem que tirar de outra. Se aprovada a PEC 241 em definitivo, em 2017 a saúde começa sendo beneficiada com cerca de R$ 10 bilhões a mais do que o previsto atualmente, segundo cálculos do Ministério da Saúde. A previsão é que o Ministério da Saúde fique com o orçamento de quase R$ 114 bilhões, 15% da Receita Corrente Líquida, projetada para R$ 758 bilhões. Porém, mesmo com o alívio no primeiro ano, entidades do setor preveem uma perda acumulada ao longo dos 20 anos de vigência.

O que muda com a PEC 241

Atualmente, pela Emenda Constitucional 86 – que é a regra vigente para os recursos da saúde – o orçamento da pasta aumentaria progressivamente, começando em 13,2% da Receita Corrente Líquida (RCL) em 2016, até 15% deste montante em 2020. A partir de então, o recurso mínimo para saúde seria 15% da RCL.

Aprovada a PEC, os recursos voltados para a saúde serão de 15% da RCL já em 2017, ou seja, percentual maior que o atualmente previsto para o período (13,7% da RCL). Porém, a partir de 2018, estes recursos deixariam de estar atrelados à RCL e passariam a ser corrigidos pelo Índice Nacional de Preços ao Consumidor Amplo (IPCA).

Ou seja, se os recursos da União crescerem mais do que a inflação, a saúde vai pegar uma fatia proporcionalmente menor deste montante, diferentemente do que acontece na regra atual, que garante que o orçamento da Saúde nunca será menor do que 15% da RCL a partir de 2020.

Em resposta às críticas, o Ministério da Saúde defende que os recursos da Saúde estão garantidos. “Com o equilíbrio de contas, em 2017, o gasto mínimo em saúde aumenta em aproximadamente R$ 10 bilhões. A partir de 2018 o gasto mínimo com saúde passará a ser corrigido pelo IPCA. Além disso, nada impede que o Poder Executivo proponha um valor acima do mínimo, ou que o Congresso aumente o valor proposto pelo Executivo, como já vem ocorrendo nos últimos anos“, disse a pasta, em nota.

Ajuste inevitável, avalia consultor

O diretor da Conultoria de Orçamento e Fiscalização Financeira da Câmara, Ricardo Volpe, que ajudou a elaborar a proposta, frisa que o Brasil está com o maior histórico de despesa pública, com 20% do PIB e para contornar a situação, o ajuste fiscal é inevitável. Para o técnico legislativo, a PEC é uma saída gradual do cenário de crise.

Volpe enfatiza que é preciso ter eficiência nos gastos e que, se Saúde e Educação são prioridades, os recursos para estas pastas devem ser tirados de outro lugar. “O gasto ser a mais em uma área ou outra depende de decisão política. Não adianta colocar mais no orçamento. Se não tiver vontade politica, não vai se gastar. Vincular recursos é uma falsa ilusão de que tem mais recurso porque o contingencia, congela a área e tira ações livres de outras áreas”, disse.

Críticas

O impacto da aprovação da PEC 241 foi criticado por entidades do setor da saúde. A Comissão Intersetorial de Orçamento e Financiamento (Cofin) do Conselho Nacional de Saúde apresentou estudo apontando para uma perda de R$ 434 bilhões ao Sistema Único de Saúde entre 2018 e 2036, caso seja aprovada a PEC 241.Para a professora do Instituto de Estudos em Saúde Coletiva da Universidade Federal do Rio de Janeiro, Lígia Bahia, uma eventual aprovação da PEC 241 seria “avassaladora“ para o SUS. “O problema da PEC não é o ano que vem, é o que ela tem de conteúdo real, um congelamento de 20 anos, como se o Brasil não tivesse nenhuma mudança no futuro”.

A especialista ressalta que para 2017 está prevista uma tríplice epidemia, de Zika, dengue e chikungunya. “O recurso para a saúde não pode ter um teto, ele tem que ser suficiente pra resolver os problemas da saúde. Certamente, nesse momento tem que ser muito grande, já que tem que prever o aumento dessas doenças infeccionas e o aumento do atendimento às vítimas de doenças crônicas, que crescem com o envelhecimento da população”, exemplificou a professora.

Nota conjunta do Conselho Nacional de Secretarias de Saúde e do Conselho Nacional de Secretarias Municipais de Saúde diz que “os efeitos do novo regime fiscal proposto serão desastrosos para todas as gestões do SUS, especialmente para as esferas estaduais e municipais do sistema”.

A União Nacional dos Dirigentes Municipais de Educação (Undime), o Colegiado Nacional de Gestores Municipais de Assistência Social (Congemas) e Conselho Nacional de Secretarias Municipais de Saúde (Conasems) também divulgaram nota conjunta com críticas à PEC. As entidades divulgaram, com base nos dados do IBGE e Orçamento Brasil, um quadro que mostra como seriam as despesas de 2002 a 2015 caso as regras da PEC fossem aplicadas.

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