Facultad de Ciencias Sociales, Universidad de los Andes, Carrera 1 # 18A-12, Bogotá, Colombia.
Asociación Colombiana de Ciudades Capitales , Carrera 9 # 80-45 Oficina 901, Bogotá, Colombia.
Int J Equity Health. 2019 Jun 3;18(1):61. doi: 10.1186/s12939-019-0961-y.
The term "judicialization of health care" describes the use of rights-based litigation to demand access to pharmaceuticals and medical treatments. The judicialization of health care in Latin America has two defining features. Firstly, it has been conducted in an individualized fashion. Secondly, it is highly pharmaceuticalized, since most public expenditure related to health rights litigation is invested in paying for costly medications. Recent studies also suggest that the judicialization of health care is bad for equity since it skews limited health resources away from the poorest citizens and in favor of the more affluent.
We used a scoping methodology to analyze the study-design and the quality of the data employed by the literature that explicitly assesses the impact of the judicialization of health care on equity in Latin American countries. Articles were selected on the basis of their use of an empirical strategy to determine the effect of the judicialization on equity. We searched Google Scholar, PubMed, Scopus, and Scielo databases. We also went through the studies' bibliographic references, and hand-searched key journals and authors.
Half of the studies analyzed find that judicialization has a negative impact on equity, but the other half finds that evidence is inconclusive or that the judicialization of healthcare has a positive effect on equity. The majority of the studies that collect their own data rely on limited samples that are sometimes not representative and mostly not generalizable. Only few studies conduct systematic comparative analysis of different cross-country or within-country cases. None of the studies reviewed aim to establish causation between judicialization and health outcomes.
We conclude that in order to prove or disprove that the judicialization of health care is at odds with equity we first need to overcome the methodological and research-design problems that have beleaguered the available empirical studies. We also conclude that pharmaceuticals' price regulation, state capacity, the behavior of litigants, prescribers and judges, and the economic interests of big-pharma, are variables that have to be incorporated into a rigorous empirical literature capable of assessing the regressive effect of health rights' litigation.
“医疗保健的司法化”一词描述了利用基于权利的诉讼来要求获得药品和医疗的做法。拉丁美洲的医疗保健司法化有两个显著特点。首先，它是以个体化的方式进行的。其次，它高度依赖于药物，因为与健康权利诉讼相关的大部分公共支出都用于支付昂贵的药物费用。最近的研究还表明，医疗保健的司法化不利于公平，因为它将有限的卫生资源从最贫困的公民转移到了较富裕的公民手中。
我们使用范围界定方法分析了明确评估医疗保健司法化对拉丁美洲国家公平性影响的文献中的研究设计和数据质量。根据使用实证策略确定司法化对公平性影响的文章入选。我们在 Google Scholar、PubMed、Scopus 和 Scielo 数据库中进行了搜索。我们还查阅了这些研究的参考文献，并手动搜索了主要期刊和作者。
一半的分析研究认为司法化对公平性有负面影响，但另一半则认为证据不确定，或者医疗保健的司法化对公平性有积极影响。大多数收集自己数据的研究依赖于有限的样本，这些样本有时没有代表性，且大多不可推广。只有少数研究对不同的跨国或国内案例进行了系统的比较分析。没有一项研究旨在建立司法化与健康结果之间的因果关系。
我们的结论是，为了证明或反驳医疗保健的司法化与公平性相悖，我们首先需要克服困扰现有实证研究的方法和研究设计问题。我们还得出结论，药品价格管制、国家能力、诉讼当事人、处方者和法官的行为以及大型制药公司的经济利益，都是必须纳入能够评估健康权利诉讼的倒退效应的严格实证文献中的变量。
