Assistant Scientist at the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Director of Global Health and Clinical Professor at the Office of Global Health, Dornsife School of Public Health, Drexel University, Philadelphia, USA.
Health Hum Rights. 2020 Jun;22(1):221-235.
Over the past three decades, Brazil has developed a decentralized universal health system and achieved significant advances in key health indicators. At the same time, Brazil's health system has struggled to ensure equitable and quality health services. One response to the broad promises and notable shortcomings has been a sharp rise in right-to-health litigation, most often seeking access to medicines. While much has been written about the characteristics of patient-plaintiffs and the requested medicines in right-to-health litigation in Brazil, little research has examined potential community-level and institutional drivers of judicialization and their role as mechanisms of accountability. To explore these dimensions, we used a mixed-effects analytical model to examine a representative sample of lawsuits for access to medicines filed against the state of Rio Grande do Sul in 2008. We found that the presence of a Public Defender's Office was associated with a sevenfold increase in the likelihood of a municipality having a medicine-requesting lawsuit. This effect was maintained after controlling for a series of municipality characteristics. As low- and middle-income countries seek to achieve universal health coverage within the framework of the Sustainable Development Goals, Brazil's experience may be illustrative of the challenges that health systems will face and the institutional mechanisms that will emerge, advancing accountability and individual patients' interests in response.
在过去的三十年中，巴西已经建立了一个去中心化的全民健康体系，并在关键的健康指标上取得了重大进展。与此同时，巴西的卫生系统一直在努力确保公平和高质量的卫生服务。为了应对广泛的承诺和明显的不足，人们对健康权诉讼的反应非常强烈，而健康权诉讼大多是为了获得药品。尽管人们已经写了很多关于巴西健康权诉讼中的患者原告和所要求药品的特征的文章，但很少有研究探讨司法化的潜在社区层面和机构驱动因素及其作为问责机制的作用。为了探索这些方面，我们使用混合效应分析模型，对 2008 年针对巴西南里奥格兰德州提出的药品获取诉讼的代表性样本进行了分析。我们发现，公共辩护人办公室的存在与一个市镇提起药品请求诉讼的可能性增加了七倍有关。在控制了一系列市镇特征后，这种影响仍然存在。随着中低收入国家在可持续发展目标的框架内寻求实现全民健康覆盖，巴西的经验可能说明了卫生系统将面临的挑战，以及将出现的机构机制，以响应提高问责制和个人患者的利益。
