• Israel Júnior Borges do Nascimento, Ana Luíza Matos de Oliveira, Paulo Henrique Costa Diniz, Maria de Fatima Leite, and Graziella Lage Oliveira.
• Clinical Pathologist (ClinPath). Medical Research Specialist, School of Medicine and University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil; and Medical Research Specialist, School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States.
• Sao Paulo Med J. 2022 Mar 1; 140 (2): 290-296.

BackgroundMultiple opinion-based communications have highlighted the actions of the Brazilian government during the pandemic. Nevertheless, none have appraised public data to identify factors associated with worsening of the healthcare system.ObjectiveTo analyze and collate data from public health and treasury information systems in order to understand the escalating process of weakening of Brazilian healthcare and welfare since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.Design And SettingSecondary data study conducted using multiple public databases administered by the Brazilian federal government.MethodsWe processed information from multiple national databases and appraised health and economic-related data.ResultsBased on our analyses, there were substantial reductions in inpatient hospital admissions and in the numbers of patients seeking primary care services, along with a decrease in immunization coverage. Moreover, we observed a considerable decline in government transfers to hospital services (reduction of 82.0%) and a diminution of public outlays in several healthcare-related subfunctions ("hospital and outpatient care", "primary care", "prophylactic and therapeutic support" and "epidemiological surveillance"). We observed an increase in the overall mortality rate over the period analyzed, especially regarding all group-based diseases. Notably, there were remarkable differences among geographic, racial, gender and other parameters, thus revealing the impact of vulnerabilities on COVID-19 outcomes.ConclusionThis assessment of documentation of public expenditure and the shrinkage of investment in sensitive areas of the healthcare system in Brazil emphasized areas that still require collective attention in order to guarantee national welfare.

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