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[药品获取的司法化:对巴西北里奥格兰德州诉讼案件的分析]

[Judicialization of access to medicines: analysis of lawsuits in the state of Rio Grande do Norte, Brazil].

作者信息

Oliveira Yonara Monique da Costa, Braga Bárbara Suellen Fonseca, Farias Andrezza Duarte, Vasconcelos Cipriano Maia de, Ferreira Maria Angela Fernandes

机构信息

Universidade Federal do Rio Grande do Norte, Natal, Brasil.

Universidade Federal de Campina Grande, Campina Grande, Brasil.

出版信息

Cad Saude Publica. 2021 Jan 11;37(1):e00174619. doi: 10.1590/0102-311X00174619. eCollection 2021.

Abstract

This study aimed to analyze the lawsuits demanding access to medicines in the state of Rio Grande do Norte, Brazil, from 2013 to 2017, describing their sociodemographic, legal, and medical/health characteristics. This was a descriptive study in which the unit of analysis was the individual judicial process for requesting medicines in which the state was the defendant. The data were obtained by consulting the website of the Rio Grande do Norte Court of Justice. A total of 987 suits were analyzed, in which the majority of the plaintiffs were females (58.8%), with a mean age of 48.3 years, and residing in the state's interior (56.9%). The legal aid was predominantly public (52.8%), and 38.1% of the prescriptions originated in the private healthcare sector. Access to the medicines was obtained in 68% of the cases, and the plaintiff was responsible for the purchase in 56.1%, via attachment of public funds. Chronic noncommunicable diseases predominated, as did demands for medicines not supplied by the Brazilian Unified National Health System (SUS). A total of 1,517 medicines were requested, of which 936 (61.7%) were not on the National List of Essential Medicines (Rename). The most frequently demanded drug was insulin glargine (74 case). Of the 10 medicines with the most lawsuits, four were later incorporated by the SUS, featuring insulin analogues. The results showed that legal recourse has been consolidated as a form of access to medicines that have still not been incorporated by the SUS, which can contribute as a form of pressure for such incorporation. The attachment of public funds to comply with these rulings is worrisome for the administration of the SUS, since it jeopardizes the execution of regularly scheduled and budgeted policies in pharmaceutical assistance.

摘要

本研究旨在分析2013年至2017年巴西北里奥格兰德州要求获得药品的诉讼,描述其社会人口学、法律以及医学/健康特征。这是一项描述性研究,分析单位是州作为被告的要求获得药品的个人司法程序。数据通过查阅北里奥格兰德州司法法院网站获得。共分析了987起诉讼,其中大多数原告为女性(58.8%),平均年龄48.3岁,居住在该州内陆地区(56.9%)。法律援助主要是公共援助(52.8%),38.1%的处方来自私营医疗保健部门。68%的案件中获得了药品,56.1%的情况下原告负责购买,通过附加公共资金实现。慢性非传染性疾病占主导,对巴西统一国家卫生系统(SUS)未提供的药品的需求也占主导。共要求提供1517种药品,其中936种(61.7%)不在国家基本药物清单(Rename)上。最常要求的药物是甘精胰岛素(74例)。在诉讼最多的10种药物中,有4种后来被SUS纳入,包括胰岛素类似物。结果表明,法律追索已成为获得SUS尚未纳入的药品的一种形式,这可作为促使此类纳入的一种压力形式。为遵守这些裁决而附加公共资金令SUS的管理部门担忧,因为这会危及药品援助中定期安排和预算的政策的执行。

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