Institutional Strategies as a Mechanism to Rationalize the Negative Effects of the Judicialization of Access to Medicine in Brazil

Abstract

Background 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, has created challenges and 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. Methods 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%. Results 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 Nonstandardized 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. Conclusion 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.

Entre justiça e gestão: colaboração interinstitucional na judicialização da saúde

“…Esse jogo repetido entre uma pluralidade de atores incentiva comportamentos estratégicos por parte dessas organizações, que passam a se antecipar e estruturar respostas mais complexas que a resolução do conflito individual. A literatura tem demonstrado que a judicialização da saúde estende no tempo as interações entre administração pública e atores do sistema de justiça, o que gera respostas mais permanentes e gerais do que decisões individuais e seu cumprimento caso a caso (Chagas, Provin, Guimarães & Amaral, 2020;CNJ, 2019;Guimarães & Palheiro, 2015;Vasconcelos, 2018Vasconcelos, , 2020Wang, 2015). Uma das respostas possíveis, discutida neste trabalho, é a coordenação de esforços em colaboração.…”