Social inequalities in lawsuits for drugs

The aim of this study was to characterize the lawsuits requesting drugs considering the economic profile of their petitioners. All lawsuits (1378) accepted against Goiânia, GO from 2003 to 2007 were analyzed. Petitioners' demographic characteristics, reported diseases, requested drugs, origin of healthcare service, and lawsuit agent were described. Complainants' addresses were georeferenced and distributed into 4 regional groups classified in accordance with the population's average income. Dwellers of wealthier regions filed court actions requesting drugs more frequently, with an average rate of 1.7 lawsuits/1000 inhabitants versus 0.55/1000 in the poorer region. Lawsuit costs were 4-fold higher in wealthier regions compared with the poorest region. Chronic diseases were involved in most lawsuits, where acute and low complexity diseases predominated among complainants living in poorer regions. Thus, social differences were reflected in the granting of health rights

Judicialização da saúde, acesso à justiça e a efetividade do direito à saúde Judicialization of the right to health, access to justice and the effectiveness of the right to health

Este artigo busca analisar os vínculos entre acesso à justiça e a efetividade de um dos aspectos do direito à saúde: o acesso aos medicamentos. Inicialmente, apresenta os desafios e as dificuldades na conceituação de saúde e do direito à saúde. Em seguida, analisa processos judiciais individuais que reivindicam dos entes públicos o fornecimento de medicamentos, no período de junho de 2007 a julho de 2008, no Tribunal de Justiça do Estado do Rio de Janeiro. Constata-se que a prescrição médica individual, a hipossuficiência econômica e a urgência dos demandantes ao acesso aos medicamentos são os principais respaldos das decisões judiciais analisadas, que determinam o fornecimento de medicamento conforme requerido pelos autores. Conclui-se que a efetividade do direito à saúde requer um conjunto de respostas políticas e ações governamentais mais amplas, e não meramente formais e restritas às ordens judiciais. As demandas judiciais não podem ser consideradas como principal instrumento deliberativo na gestão da assistência farmacêutica no SUS, mas admitidas como um elemento importante na tomada de decisão dos gestores e, muitas vezes, na melhoria do acesso aos medicamentos no âmbito do SUS. No contexto democrático brasileiro, a judicialização pode expressar reivindicações e modos de atuação legítimos de cidadãos e de instituições. O principal desafio é formular estratégias políticas e sociais orquestradas com outros mecanismos e instrumentos de garantia democrática, que aperfeiçoem os sistemas de saúde e de justiça com vistas à efetividade do direito à saúde.<br>This paper aims to analyze the links between access to justice and the effectiveness of one aspect of the right to health: access to medicines. It initially presents the challenges and difficulties in the conceptualization of health and right to health, and then analyzes individual lawsuits demanding medicines against public services, from June 2007 to July 2008, entered at Rio de Janeiro State Court of Appeals. It appears that the medical drug prescription, the economic conditions of the applicants and the urgency of access to medicines are the main factual basis of judicial sentences examined, which determine the supply of medicines as required by the authors. Finally, it concludes that the effectiveness of the right to health requires a set of policy and broader government actions, and not merely formal and restrictive court orders. The individual's claims cannot be considered as the main deliberative instrument in the management of pharmaceutical care in the Brazilian Health System, but accepted as an important element in the decision making of managers and, often, in the improvement of the access to medicines under National Health System. In the Brazilian democratic context, the judicialization can express demands and modes of action of citizens and legitimate institutions. Thus, the main challenge is to make policy and social strategies orchestrated with other mechanisms and instruments of democratic security, to improve health and justice systems in order to give effectiveness to the right to health