Institutional strategies as a mechanism to rationalize the negative effects of judicialization of access to medicine in brazil

Abstract

Recently, the Executive Branch and Judiciary in Brazil increased spending due to larger numbers of lawsuits that forced the State to provide health goods and services. This phenomenon, known as health judicialization, is related to flaws in policies and to insufficient funds available for the State to meet every demand, and it has created challenges. These challenges required the Executive Branch and Judiciary to create institutional strategies such as technical chambers and departments to reduce the social, economic and political distortions caused by this phenomenon. This study aims to evaluate the effects of two institutional strategies deployed by a Brazilian municipality in order to cope with the economic, social and political distortions caused by the phenomenon of health judicialization regarding access to medicines. A longitudinal study was carried out in a capital in the Central-West Region of Brazil. A sample of 511 lawsuits was analyzed. The variables were placed into three groups: the sociodemographic characteristics and the plaintiffs’ disease, the characteristics of the claimed medical products and the institutional strategies. To analyze the effect of the interventions on the total cost of the medicines in the lawsuits, bivariate and multivariate linear regressions with variance were performed. For the categorical outcomes, Poisson regressions were performed with robust variance, using a significance level of 5%. A reduction in the costs of medicines in the lawsuits and of the requests for medicines within the SUS formulary was verified after the deployment of the Department of Assessment of Non-Standardized Medicines (DAMNP) and the Technical Chamber of Health Assessment (CATS); an increase in processed prescriptions from the Brazilian Universal Health System was observed after the deployment of the CATS; and an increase in medicines outside the SUS formulary without a therapeutic alternative was verified after the CATS. The institutional strategies deployed were important tools to reduce the high costs of the medicines in the lawsuits. In addition, they represented a step forward for the State, provided a benefit to society and indicated a potential path for the health and justice systems of other countries that also face problems caused by the judicialization of health.

Uma proposta de ontologia para a Assistência Farmacêutica a partir das páginas da Revista Ciência & Saúde Coletiva

“…The topics brought by the articles on PS, such as pharmacoepidemiology, resource allocation, and technology assessment, are increasingly finding shared identity outside Brazil. In addition, the study of the advances made by the SUS -right to health and universal access to health care -reinforces the importance of studying system disparities brought about by context and disruption phenomena, which generate inequalities -leading for example to health-related litigation to gain access to medicines -and draw interest from the international community [45][46][47][48] .…”

Pacientes com diabetes mellitus tipo 2 em uso de medicamentos via judicial

“…1,2 Todavia, mesmo com os avanços ocorridos, na atualidade, seja por aspectos gerenciais, técnico-científicos ou pela ausência de recursos, o SUS apresenta dificuldades em cumprir seus princípios doutrinários e organizacionais. [3][4][5] Sob essa perspectiva, muitos cidadãos brasileiros buscam o poder judiciário para conseguirem acesso aos serviços de saúde e a medicamentos. 6 A judicialização da saúde é um fenômeno complexo que se baseia na demanda do sistema judiciário como alternativa para garantir o acesso ao direito à saúde.…”