O direito ao tratamento da depressão no sistema de saúde suplementar: as representações sociais dos desembargadores do Tribunal de Justiça do Estado de São Paulo

Abstract

The study identifies and analyzes the social representations of the judges of the Court of Justice of the State of São Paulo (TJSP) about the right to treatment of depression in the supplementary health system, characterizes the judicial demands related to the treatment of the referred disorder, identifies the main arguments conveyed by the plaintiffs and defendants, detects which treatments are the most legally required, verifies the existence of a medical prescription that supports the treatments, reveals the main grounds of the first jurisdictional judicial decisions on the issue and compares the results of the judgments with the results of 1st degree decisions. The methodological approach used was qualitative and quantitative. 69 judgments delivered by the judges of the TJSP between 01/01/2015 and 12/31/2019 were analyzed. The results showed that the right to treatment of depression in the supplementary health system was socially represented by the judges of the TJSP as a consumer right and, when there was a medical prescription, as a true duty of the operators. In addition to the social representations of that right, other representational constructions were found. The National Health Agency (NHA) list was represented as a mere list of procedures that cannot be used to rule out treatments that are not foreseen in it. The doctor's exclusivity to establish the treatment of depression was also a representation present in the studied judgments. The mandatory coverage of treatment in the event of a contractual provision for the disorder was another recurring representation. In addition, it was observed that more than 60% of the judgments came from lawsuits filed in the county of the state capital, that most of the lawsuits were brought by women, that the most required treatment was transcranial magnetic stimulation, that in all cases the authors instructed their requests with a medical prescription, that the supply or cost of treatment was determined in more than 90% of the actions, and that the 1st degree decisions were maintained by the TJSP in almost 80% of the cases. Such findings proved to be relevant, as they could contribute to the improvement of the assistance policy and to the rationalization of the jurisdictional provision system.