Abstract
ABSTRACTObjective:Economic evaluation of a scientific advisory program with the Public Defenders Office to mitigate the impacts of the judicialization on health in the municipality, as well as the implementation of an active follow-up program to monitor health outcomes arising from court demands.Methods:A two-step study, the first documental, retrospective, with data collection of lawsuits in the region of Barbalha (CE), Brazil, from 2013 to 2018, and the second stage, prospective and intervention, through mediation between the citizen and the Public Defenders Office, aiming to reduce the occurrence of the judicialization, and the monitoring of the health outcomes of the processes. The study adopted the Consolidated Health Economic Evaluation Reporting Standards protocol for economic health assessments. The data obtained from the processes were grouped and treated for characterization of the scenario. A comparison of the profile of the lawsuits in the period of 12 months before and after the installation of the program to delimit a complete fiscal cycle was carried out.Results:The advisory service promoted a decrease of 40% (p=0.01) in lawsuits. There was a 31% reduction in court costs (p=0.003), with medicines accounting for 33% of this amount. There was a decrease in inputs outside the Sistema Único de Saúde lists (27%; p=0.003), however there was no statistical difference among several demanding groups, suggesting an equanimous approach.Conclusion:Data from the initial survey were comparable to those reported in Brazil regarding the profile of judicial demands. In view of the scenario, the proposal proved feasible as a means to mitigate the costs of the judicialization through mediation. Finally, the initiative can serve as a model for adoption by municipalities that have characteristics similar to those presented in this study.
Highlights
Judicialization of health care is a typical feature of the Unified Health System (SUS - Sistema Único de Saúde) - Brazilian National Health System, where court decisions interfere with the compliance with healthcare policies and are enforced in an unorganized way exceeding the estimated budget.[1]. It involves ethical issues, such as the role of the Government in the mediation of individual and collective interests and rights,(2) due to the imbalance created in health planning,(3) negatively affecting the system beneficiaries.[4]
They refer to medical prescriptions that are noncompliant with the good prescription practices,(12) despite the existing legal directions for this purpose; plaintiffs’ motivations for the prescription for medicine by brand,(13) questions regarding efficacy of their clinical indications[14] and lack of scientific evidence in the prescriptions.[11]. Despite all that, medical prescription is the supreme element to support court decisions.[11]
❚❚RESULTS Characterization of the setting The city of Barbalha ranked seventh in the state in the general Human Development Index (HDI) and ninth in HDI-Education and fourth in HDI-Longevity.[22]. Regional sociodemographic characteristics are presented in table 1
Summary
Judicialization of health care is a typical feature of the Unified Health System (SUS - Sistema Único de Saúde) - Brazilian National Health System, where court decisions interfere with the compliance with healthcare policies and are enforced in an unorganized way exceeding the estimated budget.[1]. The main item requested in court is medication.[9] On the other hand, health outcomes are rarely recorded not to mention the recognized need for further academic-scientific background to expand the support to legal decisions.[10]. Such decisions have been studied, and high judicial interference is acknowledged[11] due to technical and scientific matters ignored in the decisionmaking process. Medical prescription is the supreme element to support court decisions.[11]
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