Abstract
Identify and evaluate studies that analyzed characteristics of right-to-health litigation in Brazil, Colombia, and Costa Rica. Studies were evaluated that analyzed characteristics of right-to-health litigation identified through a search of PubMed, LILACS, Cochrane Library, and Scirus (April 2012). Two reviewers evaluated the studies. Variables collected were, among others, grounds for litigation, proportion of lawsuits for benefits covered by the health system, and lawsuits on high-cost technologies. Thirty studies were identified (Brazil 19, Colombia 10, and Costa Rica 1). Judgments were frequently in favor of plaintiffs: Colombia (75%-87%), Costa Rica (89.7%), and Brazil (70%-100%). In Colombia, lawsuits were filed for benefits included in the Compulsory Health Plan (range: 41%-69.9%). In Brazil there was considerable variation in the amount of lawsuits between the Exceptional Circumstance Drug Dispensing Program (13%-31%) and basic medicines in the Unified Health System (approximately 50%). Lawsuits on drugs varied as a percentage of all lawsuits (Colombia 11.9%-35.6%, Costa Rica 30.2%, and Brazil 49.6%). A study in Brazil found a statistically significant difference when comparing lawsuits on exceptional drugs versus all other drugs, by social class; and in another study, according to lawsuits from municipalities with better socioeconomic indicators. A concentration of lawsuits on drug prescribing by a limited group of physicians was reported. Prescribing was not always supported by scientific evidence. Another study found that in half of the cases, the cost of legal proceedings was higher than the cost of the services being claimed. There are similarities in the grounds, nature, and impact of litigation in the context of the countries studied. The studies included show weaknesses of health systems to ensure access to different services as well as in the introduction of new health technologies.
Highlights
La decisión judicial fue frecuentemente favorable para los demandantes: Colombia (75%–87%), Costa Rica (89,7%) y Brasil (70%–100%)
70,5% 79,0% 53,9%(med. con evidencia de eficacia) 5%
Key words Right to health; health systems; legislation as topic; legislation, drug; review; Brazil; Colombia; Costa Rica
Summary
Reveiz L, Chapman E, Torres R, Fitzgerald JF, Mendoza A, Bolis M, et al Litigios por derecho a la salud en tres países de América Latina: revisión sistemática de la literatura. Identificar y evaluar estudios que analizaron las características de los litigios por derecho a la salud en Brasil, Colombia y Costa Rica. Se evaluaron estudios que analizaron las características de los litigios por derecho a la salud identificados mediante una búsqueda en PubMed, LILACS, Biblioteca Cochrane, Scirus (Abril, 2012). En Colombia las demandas se efectuaron por beneficios incluidos en el Plan Obligatorio de Salud (rango 41%–69,9%). En relación al total de demandas, las de medicamentos fueron variables (Colombia 11,9%–35,6%, Costa Rica 30,2% y Brasil 49,6%). Palabras clave Derecho a la salud; sistemas de salud; legislación como asunto; legislación de medicamentos; revisión; Brasil; Colombia; Costa Rica. En Colombia entre 2003 y 2009 el crecimiento anual promedio en el valor de los reembolsos por medicamentos no incluidos en el Plan Obligatorio de Salud (POS) fue de
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