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

Manoel Honório Romão^1,2,3, Jordana Crislayne de Lima Paiva¹, Elinaldo Bernardo de Oliveira Júnior¹, Andréa Santos Pinheiro¹, Thaísa Góis Farias de Moura Santos Lima^1,4, Denizar Vianna Araujo⁵, Swedenberger do Nascimento Barbosa⁶, Thiago Medeiros Camara¹, Luciana Simões Camara Leão⁴, João Maria Macedo da Costa^1*, Lorena de Macêdo Silva¹, Antônio Isidro da Silva Filho⁷, Rodrigo Pires de Campos^8,9, Karilany Dantas Coutinho¹, Érika Santos de Aragão¹⁰, Israel José dos Santos Felipe¹, Ana Paula Rodrigues Siqueira¹¹, Cláudia Miranda Veloso^12,13,14, António Quintas-Mendes^12,13,14, Ricardo Alexsandro de Medeiros Valentim¹

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¹ Laboratory for Technological Innovation in Health, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil

² Open University of Portugal, Lisbon, Portugal

³ University of Minho, Minho, Portugal

⁴ Ministry of Health, Brasilia, Brazil

⁵ Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil

⁶ Centro Internacional de Bioética e Humanidades, University of Brasilia, Brasilia, Brazil

⁷ Department of Administration, University of Brasilia, Brasilia, Brazil

⁸ Institute of International Relations, University of Brasilia, Brasilia, Brazil

⁹ University of Brasilia, Brasilia, Brazil

¹⁰ Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil

¹¹ Laboratório de Avaliações Econômicas e de Tecnologias em Saúde, Divisão de Avaliações de Tecnologias em Saúde, Instituto Nacional de Câncer, Rio de Janeiro, Brazil

¹² Research Unit in Governance, Competitiveness and Public Polices, University of Aveiro, Aveiro, Portugal

¹³ CEG, University of Aveiro, Aveiro, Portugal

¹⁴ ESTGA, University of Aveiro, Aveiro, Portugal

GHES, 025450075 https://doi.org/10.36922/GHES025450075

Received: 6 November 2025 | Revised: 25 January 2026 | Accepted: 4 March 2026 | Published online: 30 March 2026

© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )

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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.

Graphical abstract

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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