Centro Universitário FMABC (FMABC), Santo André, Brazil.
Centro Universitário de João Pessoa (UNIPÊ), João Pessoa, Brazil.
Front Public Health. 2024 Jun 25;12:1402648. doi: 10.3389/fpubh.2024.1402648. eCollection 2024.
Brazil's Unified Health System (SUS) ensures universal, equitable, and excellent quality health coverage for all. The broad right to health, supported by the Constitution, has led to excessive litigation in the public sector. This has negatively impacted the financial stability of SUS, created inequality in children and adolescents' access to healthcare, and affected communication between the healthcare system and the judiciary. The enactment of Law Number 13.655 on 25 April 2018, proposed significant changes in judicial decisions. This study aimed to investigate decision-making changes in health litigation involving children and adolescents following the implementation of the new normative model.
The study is cross-sectional, analyzing 3753 national judgment documents from all State Courts of Brazil, available on their respective websites from 2014 to 2020. It compares regional legal decisions before and after the promulgation of Law Number 13.655/2018. Data tabulation, statistical analysis, textual analysis, coding, and counting of significant units in the collected documents were performed. The results of data cross-referencing are presented in tables and diagrams.
The majority (96.86%) of legal claims (3635 cases) received partial or total provision of what was prescribed by the physician. The Judiciary predominantly handled these cases individually. The analysis indicates that the decisions made did not adhere to the norms established in 2018.
Regional heterogeneity in health litigation was observed, and there was no significant variability in decisions during the studied period, even after the implementation of the new normative paradigm in 2018. Technical-scientific support was undervalued by the magistrates. Prioritizing litigants undermines equity in access to Universal Health Coverage for children and adolescents.
巴西的全民健康覆盖体系（SUS）确保了所有人都能享受到普遍、公平和高质量的健康保障。宪法所支持的广泛健康权导致了公共部门过度的诉讼。这对 SUS 的财务稳定产生了负面影响，造成了儿童和青少年获得医疗保健的不平等，并影响了医疗保健系统与司法部门之间的沟通。2018 年 4 月 25 日颁布的第 13.655 号法律对司法判决提出了重大改革。本研究旨在调查新规范模式实施后涉及儿童和青少年的健康诉讼决策的变化。
本研究为横断面研究，分析了巴西所有州法院 2014 年至 2020 年在其各自网站上提供的 3753 份国家判决文件。比较了第 13.655/2018 号法律颁布前后的区域法律判决。对收集文件中的数据进行制表、统计分析、文本分析、编码和重要单位计数。数据交叉引用的结果以表格和图表的形式呈现。
大部分（96.86%）法律诉求（3635 例）得到了医生规定的部分或全部满足。司法机关主要单独处理这些案件。分析表明，所做的决定不符合 2018 年确立的规范。
观察到健康诉讼存在区域异质性，在所研究期间，即使在 2018 年实施新的规范范式后，决策也没有显著变化。法官对技术科学支持的重视不足。优先考虑诉讼当事人会破坏儿童和青少年普遍获得全民健康覆盖的公平性。
