EFFICIENCY AND FUNDING OF ACTIONS IN AVERAGE AND HIGH

Objective: to elucidate the relevance of the funding of the Unified Health System on the efficiency of medium and high complexity actions in the services. Method: it is a bibliographical study, of integrative review of the literature type. The articles were selected from 2007 to 2016, in the databases LILACS, MEDLINE and ColecionaSUS, in the Portuguese language. The research was structured in six methodological stages. After the systematized reading of the articles, the studies were analyzed and presented in the form of figures. Results: three studies were selected that show that the scientific production presented is very small and needs to be deepened in relation to the research and the inferences of contribution to the improvement of the processes in the medium and high complexity levels, especially in the consequences that the obstacles to hospital services. Conclusion: there is a need to deepen the existing gaps in the current methodology for financing services so that tools can be fostered that enable continuous improvement of processes and ensure the real efficiency of the distribution of resources to a system that generates positive health outcomes. Descriptors: Health Care Funding; Resource allocation; Health policies; Health services; Unified Health System; Nursing. RESUMO Objetivo: elucidar a relevância do financiamento do Sistema Único de Saúde sobre a eficiência das ações na média e alta complexidades nos serviços. Método: trata-se de um estudo bibliográfico, tipo revisão integrativa da literatura. Selecionaram-se os artigos no período de 2007 a 2016, nas bases de dados a LILACS, MEDLINE e ColecionaSUS, no idioma português. Estruturou-se a pesquisa em seis etapas metodológicas. Após a leitura sistematizada dos artigos os estudos foram analisados e apresentados em forma de figuras. Resultados: selecionaram-se três estudos que revelam que a produção científica apresentada é bastante reduzida e necessita de maior aprofundamento em relação à investigação e às inferências de contribuição para a melhoria dos processos em nível da média e alta complexidades, sobretudo nas consequências que os entraves causam aos serviços hospitalares. Conclusão: necessita-se de maior aprofundamento no tocante às lacunas existentes na atual metodologia de financiamento dos serviços para que sejam fomentadas ferramentas que possibilitem a melhoria contínua dos processos e garantam a real eficiência da distribuição de recursos para um sistema que gere resultados positivos em saúde. Descritores: Financiamento da Assistência à Saúde; Alocação de Recursos; Políticas de Saúde; Serviços de Saúde; Sistema Único de Saúde; Enfermagem. RESUMEN Objetivo: elucidar la relevancia del financiamiento del Sistema Único de Salud sobre la eficiencia de las acciones en la media y alta complejidad en los servicios. Método: se trata de un estudio bibliográfico, tipo revisión integrativa de la literatura. Se seleccionaron los artículos 2007 a 2016, en las bases de datos LILACS, MEDLINE y ColecionaSUS, en el idioma portugués. Se estructuró la investigación en seis etapas metodológicas. Después de la lectura sistematizada de los artículos los estudios fueron analizados y presentados en forma de figuras. Resultados: se seleccionaron tres estudios que revelan que la producción científica presentada es bastante reducida y necesita una mayor profundización en relación a la investigación y las inferencias de contribución para la mejora de los procesos a nivel de la media y alta complejidades, sobre todo en las consecuencias que los obstáculos causan a los servicios hospitalarios. Conclusión: se necesita mayor profundización en cuanto a las lagunas existentes en la actual metodología de financiamiento de los servicios para que se fomenten herramientas que posibiliten la mejora continua de los procesos y garanticen la real eficiencia de la distribución de recursos para un sistema que genere resultados positivos en salud Descritores: Financiación de la Atención de la Salud; Asignación de Recursos; Política de Salud; Servicios de Salud; Sistema Único de Salud; Enfermería. Master student, University of Pernambuco / UPE. Recife (PE), Brazil. Email: diegooliveira@asces.edu.br ORCID iD: https://orcid.org/0000-0003-1754-7275; Undergraduate students. Tabosa de Almeida University Center / ASCES / UNITA. Caruaru (PE), Brazil. E-mail: tarciany.roberta@gmail.com ORCID iD: https://orcid.org/0000-0001-5189-4794; Email: cesarocds@hotmail.com ORCID iD: https://orcid.org/0000-0002-8020-9087; Email: monnyluua@gmail.com ORCID iD: https://orcid.org/0000-0003-2395-298X; Email: wyllaneydewellen@hotmail.com.br ORCID iD: https://orcid.org/0000-0001-7476-7245; Email: raffalira1@hotmail.com ORCID iD: https://orcid.org/0000-0003-4489-1733; Master, Tabosa de Almeida University Center/ ASCES / UNITA. Caruaru (PE), Brazil. Email: lidianebarbosa@asces.edu.br iD: https://orcid.org/0000-0002-9278-9234; Master (PhD student), Tabosa de Almeida University Center/ASCES/UNITA. Caruaru (PE), Brazil. Email: cintianegotita4@gmail.com ORCID iD: https://orcid.org/0000-0003-0231-601X INTEGRATIVE REVIEW ARTICLE Oliveira DAL, Melo TRC, Santos OC dos et al. Efficiency and funding of actions in average... English/Portuguese J Nurs UFPE online., Recife, 13(2):464-71, Feb., 2019 465 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v13i02a235067p464-471-2019 The purpose of the financing of the public health sector is to analyze and manage the needs of the Unified Health System (UHS), providing them with the necessary capital and seeking to guarantee the principles of universality, integrality and equality for all Brazilian citizens who have the right to life support.1 The Brazilian health system is formed through a complex network of complex and complementary investment networks, starting from the public and private, especially from the private. There are three financing subsectors: the public, private sub-sector and the supplementary health sub-sector. In the public sub-sector, a large part of the budget is destined to the UHS, with resources provided and subsidized by the three governmental spheres. The objective is to obtain control of expenses and a better distribution of resources from these financing measures. In order to achieve this achievement, the Constitutional Amendment (CA) 29 was drawn up, which brings with it art. No. 198 of the Federal Constitution (FC). The calculation basis for the minimum application in actions and public health services (APHS), and art. 77, which refers to the Transitional Constitutional Provisions (TCP), guaranteeing the minimum resources to be applied in favor of health practices. Various forms of implementation were discussed in order to obtain a cost control, with the purpose of rationalizing the costs of the system, seeking resources and improving it in order to increase the quantity and quality of the assistance and the processes of the system. universality, completeness and equality, as recommended by the programmatic bases of the Unified Health System (UHS). Inequalities in health status are associated with social organization, tending to reflect the degree of inequity in each society, in order to perceive that the reduction of costs of UHS spending significantly affects the most vulnerable social groups. It is difficult to cut expenses in the emergency and emergency services and prompt care through budgetary control of expenditures, because such services meet the population in great demand, as well as their length of service is longer. It is reported that it is a situation in which there is a need for budgetary restraint, it is assumed that health promotion and prevention actions and services are the most affected, which is not a good public health choice since prevention is easier than treating, since most situations can be avoided. The need to identify the needs and controls of the health services provided in Brazil is considered, in order to guarantee a good assistance and with ample coverage within the predisposed budgetary standards. There is a need for an ethical review of the formality of actions and resource distributions, as well as reference should be made to the basic principles of public health in order to guarantee the basic budget relationships required for assistance. • To elucidate the relevance of the financing of the Unified Health System on the efficiency of actions in the medium and high complexity in services. It is a bibliographical study, type integrative review of the literature, carried out in December 2017. Articles were selected from 2007 to 2016, in the databases LILACS, MEDLINE and ColecionaSUS, in the Portuguese language. It is argued that this study provides the synthesis of knowledge and the incorporation of the applicability of results of significant studies in practice, as well as delimits topic or issue, in a systematic and orderly manner, contributing to the deepening of knowledge of the subject under investigation. The research was guided, based on the establishment, in the first stage, of the guiding question: "How does financing in the Unified Health System guarantee the efficiency of actions of medium and high complexity in public health services?" In the second stage, the search for articles was carried out and carried out in December 2017. The databases of Latin American and Caribbean Literature in Health Sciences (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) and ColecionaSUS were chosen as the research environment. The following descriptors (DECS / BIREME) in the Portuguese language were used for the search: Health Care Financing OR Resource Allocation AND Single Health System OR Health Policy AND Health Services. The articles published in the period 2007 to 2016, with full text, in the Portuguese language and of free access in the databases were included. Repeated productions, course and residency work, theses, dissertations, editorials, abstracts, opinion and literature reviews, INTR

The purpose of the financing of the public health sector is to analyze and manage the needs of the Unified Health System (UHS), providing them with the necessary capital and seeking to guarantee the principles of universality, integrality and equality for all Brazilian citizens who have the right to life support.¹The Brazilian health system is formed through a complex network of complex and complementary investment networks, starting from the public and private, especially from the private.There are three financing subsectors: the public, private sub-sector and the supplementary health sub-sector.In the public sub-sector, a large part of the budget is destined to the UHS, with resources provided and subsidized by the three governmental spheres. 2,3e objective is to obtain control of expenses and a better distribution of resources from these financing measures.In order to achieve this achievement, the Constitutional Amendment (CA) 29 was drawn up, which brings with it art.No. 198 of the Federal Constitution (FC).The calculation basis for the minimum application in actions and public health services (APHS), and art.77, which refers to the Transitional Constitutional Provisions (TCP), guaranteeing the minimum resources to be applied in favor of health practices. 4rious forms of implementation were discussed in order to obtain a cost control, with the purpose of rationalizing the costs of the system, seeking resources and improving it in order to increase the quantity and quality of the assistance and the processes of the system.universality, completeness and equality, as recommended by the programmatic bases of the Unified Health System (UHS). It is difficult to cut expenses in the emergency and emergency services and prompt care through budgetary control of expenditures, because such services meet the population in great demand, as well as their length of service is longer.It is reported that it is a situation in which there is a need for budgetary restraint, it is assumed that health promotion and prevention actions and services are the most affected, which is not a good public health choice since prevention is easier than treating, since most situations can be avoided. 4e need to identify the needs and controls of the health services provided in Brazil is considered, in order to guarantee a good assistance and with ample coverage within the predisposed budgetary standards.There is a need for an ethical review of the formality of actions and resource distributions, as well as reference should be made to the basic principles of public health in order to guarantee the basic budget relationships required for assistance. 4To elucidate the relevance of the financing of the Unified Health System on the efficiency of actions in the medium and high complexity in services.
It is a bibliographical study, type integrative review of the literature, carried out in December 2017.Articles were selected from 2007 to 2016, in the databases LILACS, MEDLINE and ColecionaSUS, in the Portuguese language.
It is argued that this study provides the synthesis of knowledge and the incorporation of the applicability of results of significant studies in practice, as well as delimits topic or issue, in a systematic and orderly manner, contributing to the deepening of knowledge of the subject under investigation. 7The research was guided, based on the establishment, in the first stage, of the guiding question: "How does financing in the Unified Health System guarantee the efficiency of actions of medium and high complexity in public health services?"In the second stage, the search for articles was carried out and carried out in December 2017.abstracts of congress proceedings, newsletters and program files were excluded.

The databases of
In the third stage, a reading of the abstracts of the publications was carried out in order to understand their relation with the purpose of this study and with the guiding question and to allow its categorization using the validated instrument 8 as a means of standardizing the most relevant in carrying out the review studies.Productions that did not fit the sample composition of this review were eliminated.In the fourth stage, a critical analysis of the publications identified as components of the study sample.
After the categorization stage and the critical reading of the publications, in the fifth stage, the product of the critical analysis and instrumented to the interpretation of the data of impact for the study was interconnected to the theoretical product developed in the health sciences and using as a supporting tool, Melnyk and Fineout-Overholt's proposal for the classification of publications by level of evidence.In the last stage, the result of the search and analysis was expressed in order to show the contributions of this one to the better understanding of the process with the practice and to establish, from this information gathering, measures for the improvement in the development of these actions. 9e selection process of the scientific articles was done as follows: initially, 1,279 publications were identified.1,277 were excluded because they did not meet the eligibility criteria previously defined, thus leaving 20 publications.It is shown, after careful reading of titles and abstracts, 17 articles were left excluding only three articles analyzed by reading in full text and included in this integrative review.Figure 1 shows the process of selecting articles during the data collection procedure.

RESULTS
Studies included in the review (n= 3) The material included is included in publications in Portuguese.It is noted that publications in other languages were not included because the analysis data are developmentally related to the Brazilian policy in health.The publications for the analysis were used, grouping them in figure 2, after the registration and the application of the instrument of data collection.The search carried out and the process of critical reading developed in the stages of the review were instrumentalized the means for the analysis, as shown in figure 3. The difficulties in the distribution of goods and resources in a fair way were understood, in the face of moral pluralism, a striking feature in the current panorama where, also, we do not accept values considered absolute and several concepts coexist.It is perceived that there is an urgent need to review questions about how the fair distribution of resources should occur, not only for health professionals and managers, but also for the population, who must democratically expose and add, in their ideas.It   The sample analyzed is mostly analyzed as evaluation studies, one of which is related to the reflection of the bioethical context and to the distribution of funding in the UHS.We evaluate the publications in relation to the proposal of levels of evidence of publications, it is observed that the production of studies that report strong evidences that assist the managers for the decision making and contribute in a way to improve and to reflect on the possibilities improvement in the context of the financing of hospital services. 9 is known that financing is one of the strategies to guarantee the effectiveness of UHS principles.For this, it is necessary that the distribution of these resources occurs in an appropriate way so that the universality and the integrality of the actions in services can be assured. 10,11 is revealed that adequate funding and transfer of resources are of fundamental importance to ensure that health services are able to meet the needs of the population, and for this, an analysis of the determinants and constraints of each locality is necessary, because, in this way, it is possible to appropriately allocate health resources. 10us, there is a need for the correct use of resources, through planning, so that the objectives can be achieved and the actions of services can guarantee better service in the health sectors.It is now known that financing has been scarce to meet the most emerging needs and this has become a challenge for the management of services, being necessary to put the principle of efficiency in practice, which brings great benefits, since it provides that few resources have correct destinations so that they can achieve the objectives. 10,14tention to all the dimensions that the UHS covers during the financing process is fundamental, such as the provision of its services and its target audience, in order not to undermine fundamental actions that guarantee access and assistance of quality.The values of the federal spheres are transferred to the state, and from the state to the federal, in order to obtain the minimum cost ratio for the guarantee of the public health practices in their localities.

ID
It is necessary, in order to achieve the efficiency of actions in UHS services, to allocate resources in an equitable manner so as to ensure a better quality of care, since the onlendings will be made so that the health needs of each population.It is reported that, it is not enough, just, to occur the equal distribution of resources, since each region has its peculiarities and different determinants. 12 a study carried out in the State of Bahia, in which the distribution of federal financial resources was analyzed in the perspective of equity, the transfers are proportional to the Municipal Human Development Index (MHDI), that is, the higher the MHDI, the higher the transfer.It was analyzed, that this method of transfer does not guarantee the equity since they need more attention in health the places with lower MHDI, that are those that are less able to guarantee a quality assistance.Adopting other indicators is important to indicate which regions have the greatest need for resources, making it possible to cover the needs of those who need it the most.12 The paradigms of equality and equity must be embedded in health models, ensuring that resources are properly distributed and that they address health inequities.12

DISCUSSION
Português/Inglês Rev enferm UFPE on line., Recife, 13(2):464-71, fev., 2019 470 Health care priorities are prioritized according to the hierarchical choices between existing care alternatives and system resource limits.It is known that health needs exceed available resources, and ethical choices have to be made on how to solve problems.Three solution alternatives are established; the first is to increase resources, the second is to make spending more efficient, and the third is to prioritize the distribution of existing resources. 13 is necessary, in order to make the decision of priority in the distribution of resources, to reflect two ethical parameters: social utility and equity.It is emphasized that in social utility, according to the utilitarian theory, those who provide more health to the greatest number of people, that is, the maximization of well-being or general health, would be prioritized.It is reported that health equity would serve people with different needs, according to their social and health conditions, that is, to attend each one according to their needs. 13e Federal Constitution of 1988, Art. 196, states that "Health is the right of all and the duty of the State, guaranteed by social and economic policies aimed at reducing the risk of disease and other universal and equal access to actions and services for their promotion, protection and recovery." Three doctrinal principles are recommended by the UHS to guarantee the right to health: universality, completeness and equity.It is shown that this bases the study in which equity and social utility should be taken into account in order to prioritize the distribution of health resources. 15,4 was evidenced in the literature that there are still gaps to be solved and standardized for the real efficiency of resource allocation and financing of actions in the medium and high complexities in UHS.Funding measures are established in medium and high complexity services that go beyond not only the sphere of understanding of resource allocation, but also in Brazil a social, political and economic context of high fragility, with better targeting needs planned, based on principles -especially ethical -and that are directed at solving emerging problems in order to be efficient with those who use the Unified Health System in this mode of care.It is reported that this study provides professionals, especially in the management of hospital services, with a reflection on the discussion measures and better allocation of resources for the efficiency of services to the population.
It was presented as a difficulty to find studies that deal with financing in medium and high complexities, evidencing the scarcity of publications in the databases and, consequently, culminating in the effort for the critical analysis proposed in this review.It is necessary, on the face of it, that, for a better evidence in the reflections, studies are developed that accurately evaluate the effectiveness and effectiveness of the actions directed to this context.