Dissertação
Notas técnicas, respostas técnicas rápidas: seus usos para embasar as decisões judiciais em saúde no Estado de Minas Gerais, Brasil
Fecha
2018-02-26Autor
Semíramis Domingues Diniz
Institución
Resumen
The number of lawsuits regarding access to health services and inputs has
increased and impacted the Brazilian National Health System (SUS). It is
estimated that the expenditure to attend health litigation in 2017 was US$ 2,2
billion. The state of Minas Gerais has followed this tendency: from January to
November 2017, about 14400 deferred lawsuits were received by Minas Gerais’
Health Secretary. Great part of these demands is for medicines that are mostly
off SUS’ free-distribution medicines list. Nevertheless, public supply of these
medicines is widely deferred by judges. In an attempt to equate the
phenomenon, Judiciary has assumed an active role in this process. It has
defended and structured new institucional bases for litigation through the
integration of judicial actions and Evidence Based Medicine (EBM). The
Brazilian National Justice Council published in 2010 recommendation advising
Courts of Justice to sign technical support agreements in order to substantiate
judicial decisions according to EBM. The state of Minas Gerais signed an
agreement from 2012 to 2014 with the Health Technology Assessment Nucleus
(HTAN) – an instituition linked to the Federal University of Minas Gerais – for
provision of Technical Notes (TN) and Quick Technical Responses (QTR).
Despite this iniciative’s relevance, it is still necessary to evaluate to what extent
the consideration of EBM affects the judicial decisions. This research aimed
mainly to analyze conformity between the TN or the QTR recommendation and
the judicial decisions for the same case. A retrospective descriptive study was
carried out based on information from NTs and RTRs available on Court of
Justice of Minas Gerais’ website, which were produced by HTAN from 2012 to
2015. A standardized formulary was created to colect the variables of interest:
medication requested, disease of the litigant, provision by SUS (yes / no),
alternative therapy within SUS (yes / no), technical recommendation, judicial
decision. 266 NTs and their respective legal proceedings covering 373
applications for medicines and 478 RTR and its relative actions, covering 1108
drugs were analyzed. In order to verify the proportion of concordance between
judicial decision and technical recommendation, the columns "technical
recommendation" and "judicial decision" were compared. The concordance
analysis results show that, in 61% of the cases, NT was contrary to the drug
dispensing while judicial decision was favorable. Moreover, in 75% of the cases,
RTR was contrary to the drug dispensing while judicial decision was favorable.
The results indicate that technical contribution contraindicating the concession
of certain medicines were not decisive for the judicial decision. It is worth
questioning the dilemmas that would remain in a scenario in which the judicial
action began to fully adopt the technical guidelines provided and to what extent
it would impact the incorporation of technologies by SUS.