The results of the analysis of the impact of Brazil’s Bolsa Familia conditional cash transfer program on the health of non-beneficiary households living in poverty are presented.
It analyzes whether the health requirements of the Bolsa Familia BF program lead to a reduction in health services and resources for poor non-beneficiary families who rely on public health care. The main results are: i) The implementation of the BF program led to a lower risk of infant mortality for beneficiary families, but to a higher risk than expected for impoverished non-beneficiary families. This suggests negative spillover effects on the health of non-beneficiaries. ii) The expansions of the BF program were associated with a reduction in municipal spending on primary health care, as more resources were allocated to monitor compliance with BF health conditions. iii) BF beneficiaries had greater access to coordinated primary care services (such as the Family Health Program) compared to non-beneficiaries with similar incomes, which may have contributed to the bifurcation in infant mortality outcomes.
The paper concludes that the negative effects of the BF program on the health of individuals in poor non-beneficiary families raise questions about the appropriateness of conditioning cash transfers on health care utilization, especially in settings with limited public health budgets. It is suggested that unconditional transfers or increased health system resources may be preferable.