Resumen
El estudio analizó la evidencia científica sobre la relación entre gestión presupuestaria y calidad del gasto público en salud. Se realizó una revisión sistemática siguiendo PRISMA 2020, con 17 estudios publicados entre 2021 y 2026. La evidencia fue organizada en cinco dimensiones: planificación y asignación presupuestaria, ejecución y eficiencia, gobernanza, equidad y fragmentación, y sostenibilidad financiera. Los hallazgos muestran que la calidad del gasto no depende únicamente de la disponibilidad de recursos, sino también de la capacidad institucional para planificarlos, distribuirlos y ejecutarlos eficientemente. La gobernanza y la equidad constituyeron condiciones transversales, mientras que la fragmentación financiera y las restricciones presupuestarias limitaron el desempeño de los sistemas sanitarios. Se concluye que la gestión presupuestaria y la calidad del gasto mantienen una relación multidimensional, cuya evaluación requiere integrar criterios financieros, institucionales, distributivos y de sostenibilidad.
Citas
[2] M. M. Rahman, T. I. Dyuti, M. Tareque, and M. Alnour, “Health expenditure, governance and SDG3 nexus: A longitudinal analysis in BRICS economies,” Globalization and Health, 2025, doi: 10.1186/s12992-025-01113-8.
[3] M. A. Zúñiga-Olivares, Á. Mendes, and L. Carnut, “Analysis of changes in public spending on health in Peru during the COVID-19 pandemic,” Saúde e Sociedade, 2024, doi: 10.1590/S0104-12902024240250es.
[4] E. Serván-Mori, D. Cerecero-García, C. Pineda-Antúnez et al., “Health financing inequality in fragmented health systems: Evidence from Mexico, 2000–2023,” International Journal for Equity in Health, 2026, doi: 10.1186/s12939-025-02735-5.
[5] M. Irurzun-Lopez, M. Jeffreys, and J. Cumming, “Protecting primary healthcare funding in Aotearoa New Zealand: A cross-sectional analysis of funding data 2009–2023,” Journal of Primary Health Care, 2025, doi: 10.1071/HC24155.
[6] M. G. França, A. I. da Silva, and R. Zuccolotto, “Public health expenditures in Vitória/ES: Priority for primary care,” Ciência & Saúde Coletiva, 2025, doi: 10.1590/1413-81232025307.17062023.
[7] D. F. Gomes and C. C. R. da Silva, “Spending on primary health care in large cities in the state of Ceará from 2018 to 2021,” Revista Brasileira de Políticas Públicas, 2024, doi: 10.5102/rbpp.v14i2.9224.
[8] J. A. Asamani, S. B. K. Bediakon, H. Ismaila et al., “Ballpark estimates of budget space for health workforce investments in the 47 countries of the WHO African Region: A modelling study,” Health Services Insights, 2025, doi: 10.1177/11786329251320429.
[9] A. Bhorat, D. Nel, L. Cairncross, and M. Visser, “A turn for the worse: The impact of deteriorating healthcare spending in South Africa,” South African Medical Journal, vol. 116, no. 4, 2026, doi: 10.7196/SAMJ.2026.v116i4.3068.
[10] N. I. Mkhize, “Critical assessment of health financing indicators and expenditure in South Africa,” Health SA Gesondheid, vol. 31, 2026, doi: 10.4102/hsag.v31i0.3142.
[11] J. Wishnia and J. Goudge, “Impact of financial management centralisation in a health system under austerity: A qualitative study from South Africa,” BMJ Global Health, 2021, doi: 10.1136/bmjgh-2020-003524.
[12] S. Mayanz, “Efficiency of the Chilean health system: Comparative analysis between health services,” Revista Médica de Chile, 2022, doi: 10.4067/S0034-98872022001101501.
[13] H. Njie, E. Dale, and U. Gopinathan, “Procedural fairness in decision-making for financing a National Health Insurance Scheme: A case study from The Gambia,” Health Policy and Planning, 2023, doi: 10.1093/heapol/czad063.
[14] E. Quizhpe Ordóñez, M. San Sebastián, E. Terán, and A.-M. Pulkki-Brännström, “Did health reform improve financial protection for disadvantaged groups in Ecuador? A socio-economic inequality assessment of catastrophic health expenditures 2006–2014,” BMJ Open, 2025, doi: 10.1136/bmjopen-2025-100522.
[15] A. Sharma, “Do publicly funded health insurance schemes reduce out-of-pocket expenditure? Evidence from India,” BMC Health Services Research, 2026, doi: 10.1186/s12913-026-14456-8.
[16] C. Crookes, R. Palladino, P. Seferidi, R. Hirve, O. Siskou, and F. T. Filippidis, “Impact of the economic crisis on household health expenditure in Greece: An interrupted time series analysis,” BMJ Open, 2021, doi: 10.1136/bmjopen-2020-038158.
[17] S. V. Mokoena and P. Naidoo, “Financing the national health insurance in South Africa to achieve an appropriate degree of coverage of effective health services and levels of financial protection,” Pan African Medical Journal, 2025, doi: 10.11604/pamj.2025.52.66.44779.
