The judicialization of medicines in a Western Amazon State: a patient and state relationship

Abstract

Introduction: during the process of becoming ill, users of the Unified Health System may need to access health technologies, including medication, to regain their health. Given the diversity of technologies used in health care and their constantly growing arsenal, it is difficult to make them viable for public health agencies. However, given the limitation of the public power in providing medication, the judicialization of medication materializes, since Brazilians, protected by the Federal Constitution of Brazil, are assured the right to health, established in Art. 196, as a right of all and a duty of the State, including pharmaceutical assistance. Objective: analyze the Unified Health System users’ access to medication, through the intervention of the Judiciary. Methods: this is a qualitative study conducted with two focus groups, divided into two consecutive days, in Rio Branco/Acre, in November 2017. Ten users of the Unified Health System who resorted to the Judiciary to obtain medication, five prescribing physicians working in the Unified Health System and three employees of the Judiciary participated, totaling a sample of eighteen participants. The users were randomly selected from among those patients existing in the State Department of Health of Acre judicialization database. The data obtained in the focus groups were treated according to the content analysis proposed by Bardin. Results: the majority of users demonstrate a clear perception of their constitutionally established right to access medication, regardless of the purchase price, although they feel of lesser value, since it is necessary to face an arduous battle until reaching the Judiciary. Prescribing physicians understand that some medications, in some situations, may be prescribed in disagreement with their indication/protocols/lists of the Unified Health System, in the search for the recovery of the citizen’s health. The employees of the Judiciary recognize the issue of the citizen’s constitutional right to health, refer to the difficulty of the State in enforcing health rights and the possible disorganization of management, including the inadequate management of public resources, and consider compliance with current health policies, although, in most cases, they tend to be favorable to the users demanding the medication. Conclusion: in the process of accessing necessary health treatments, Unified Health System users occasionally seek the prescribed medication, included (30%) or not (70%) in the Unified Health System protocols, from the state/municipal health management (health care networks), and, when denied, they resort to the Judiciary via the judicialization of health. Financial vulnerability of users, non-inclusion of medications requested in court in the Unified Health System medication lists, administrative denial of the medication and high financial cost of the medications were pointed out by users as determining factors for the judicialization of health. There is a clear perception of the fundamental right to prescribed medication, and that the judicial system is the decision-making and resolution body when they are denied access to necessary health treatments by the State’s administrative bodies.