Evasão estratégica das regulações: a judicialização do sistema privado de saúde brasileiro

Abstract

The article aims to advance the understanding of the successive circumvention of regulations by organizations, to determine whether it is possible to characterize them as purposeful actions, while the institutional literature analyzes decoupling and circumvention as sporadic activities. It analyzes the responses adopted by health plan companies to favor their interests, responses that often fail to comply with the rules of the institutional context, and which boosted the phenomenon known as ‘judicialization’. The study analyzed 158 lawsuits collected from the electronic archives of the Court of Justice of São Paulo, where beneficiaries sue health plan companies because of treatment coverage denial. Using correspondence and thematic analysis, some associations between denials and allegations showed to be significant, suggesting companies’ strategic patterns. It was possible to identify different strategic practices adopted by companies to avoid complying with institutional guidelines, and to observe that certain regulatory features can contribute to non-compliance strategies. The article contributes to the institutional literature by identifying organizational practices meant to successively circumvent and confront institutional prescriptions, indicating that health plan companies apparently design specific strategies to respond to beneficiaries’ demands.

Análise visual aplicada em processos de judicialização de doenças raras do estado de São Paulo

“…Antes de optar pela judicialização, os clientes podem optar por canais como o Programa de Proteção e Defesa do Consumidor (Procon), a Agência Nacional de Saúde Suplementar (ANS) e as próprias operadoras dos planos de saúde. Os autores concluíram que quando se trata de procedimentos médicos, os tribunais asseguram imediatamente a cobertura procurada por meio de uma medida cautelar, deixando o mérito da causa para outro momento (Ryngelblum, Oliveira, Telles, & Costa, 2019).…”