Reveiz Ludovic, Chapman Evelina, Torres Rubén, Fitzgerald James F, Mendoza Adriana, Bolis Mónica, Salgado Osvaldo
Área de Sistemas de Salud Basados en Atención Primaria de la Salud (HSS), Organización Panamericana de la Salud, Washington DC, USA.
Rev Panam Salud Publica. 2013 Mar;33(3):213-22. doi: 10.1590/s1020-49892013000300008.
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.
识别并评估分析巴西、哥伦比亚和哥斯达黎加健康权诉讼特征的研究。
对通过检索PubMed、LILACS、Cochrane图书馆和Scirus（2012年4月）所确定的分析健康权诉讼特征的研究进行评估。两名评审员对这些研究进行评估。收集的变量包括诉讼理由、卫生系统覆盖福利的诉讼比例以及关于高成本技术的诉讼等。
共识别出30项研究（巴西19项、哥伦比亚10项、哥斯达黎加1项）。判决结果常有利于原告：哥伦比亚（75%-87%）、哥斯达黎加（89.7%）和巴西（70%-100%）。在哥伦比亚，针对《强制健康计划》所涵盖福利提起的诉讼（范围：41%-69.9%）。在巴西，特殊情况药品配给计划的诉讼数量（13%-31%）与统一卫生系统中的基本药品诉讼数量（约50%）之间存在较大差异。药品诉讼在所有诉讼中的占比各不相同（哥伦比亚11.9%-35.6%、哥斯达黎加30.2%、巴西49.6%）。巴西的一项研究发现，按社会阶层比较特殊药品诉讼与所有其他药品诉讼时存在统计学显著差异；另一项研究则根据社会经济指标较好的城市的诉讼情况得出此结论。据报告，有限的一组医生的药品处方诉讼集中。处方并非总是有科学证据支持。另一项研究发现，在一半的案例中，法律程序的成本高于所主张服务的成本。
在所研究国家的背景下，诉讼的理由、性质和影响存在相似之处。所纳入的研究显示了卫生系统在确保获得不同服务以及引入新卫生技术方面的弱点。
