机构策略作为一种机制，以合理化巴西获得药物司法化的负面影响。

Institutional strategies as a mechanism to rationalize the negative effects of the judicialization of access to medicine in Brazil.

机构信息

Federal University of Goiás, Goiânia, 38 Luzia Miranda St. Jataí, Goiás, 75800-000, Brazil.

出版信息

BMC Health Serv Res. 2020 Feb 3;20(1):80. doi: 10.1186/s12913-020-4929-9.

DOI:10.1186/s12913-020-4929-9

PMID:32013963

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6998206/

Abstract

BACKGROUND

Recently, the Executive Branch and Judiciary in Brazil increased spending due to larger numbers of lawsuits that forced the State to provide health goods and services. This phenomenon, known as health judicialization, has created challenges and required the Executive Branch and Judiciary to create institutional strategies such as technical chambers and departments to reduce the social, economic and political distortions caused by this phenomenon. This study aims to evaluate the effects of two institutional strategies deployed by a Brazilian municipality in order to cope with the economic, social and political distortions caused by the phenomenon of health judicialization regarding access to medicines.

METHODS

A longitudinal study was carried out in a capital in the Central-West Region of Brazil. A sample of 511 lawsuits was analyzed. The variables were placed into three groups: the sociodemographic characteristics and the plaintiffs' disease, the characteristics of the claimed medical products and the institutional strategies. To analyze the effect of the interventions on the total cost of the medicines in the lawsuits, bivariate and multivariate linear regressions with variance were performed. For the categorical outcomes, Poisson regressions were performed with robust variance, using a significance level of 5%.

RESULTS

A reduction in the costs of medicines in the lawsuits and of the requests for medicines within the SUS formulary was verified after the deployment of the Department of Assessment of Nonstandardized Medicines (DAMNP) and the Technical Chamber of Health Assessment (CATS); an increase in processed prescriptions from the Brazilian Universal Health System was observed after the deployment of the CATS; and an increase in medicines outside the SUS formulary without a therapeutic alternative was verified after the CATS.

CONCLUSION

The institutional strategies deployed were important tools to reduce the high costs of the medicines in the lawsuits. In addition, they represented a step forward for the State, provided a benefit to society and indicated a potential path for the health and justice systems of other countries that also face problems caused by the judicialization of health.

摘要

背景

最近，巴西的行政部门和司法部门因更多的诉讼而增加了支出，这些诉讼迫使国家提供卫生商品和服务。这种现象被称为卫生司法化，给行政部门和司法部门带来了挑战，需要创建技术分庭和部门等机构策略，以减少这种现象造成的社会、经济和政治扭曲。本研究旨在评估巴西一个城市部署的两种机构策略的效果，以应对卫生司法化现象对药品获取造成的经济、社会和政治扭曲。

方法

在巴西中西部的一个首府进行了一项纵向研究。分析了 511 起诉讼案件。将变量分为三组：社会人口特征和原告疾病、所要求的医疗产品特征和机构策略。为了分析干预措施对诉讼中药品总成本的影响，进行了双变量和多变量线性回归分析，并进行了方差分析。对于分类结果，使用稳健方差进行了 Poisson 回归分析，显著性水平为 5%。