Judicialização da saúde: revisão de escopo em estratégias para o gestor público
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Data
2023-07-27
Autores
Leite, Mauro Salles Ferreira
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Universidade Estadual Paulista (Unesp)
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Introdução: A judicialização da saúde é o fenômeno caracterizado pelo processo em que os indivíduos recorrem ao sistema judiciário para ter acesso a medicamentos e outros bens e serviços de saúde. Objetivo: O objetivo desta revisão é mapear as estratégias implementadas pelos sistemas de saúde no Brasil para lidar com o fenômeno de judicialização da saúde, a fim de racionalizar os gastos públicos e os aspectos financeiros associados, bem como se, nas estratégias adotadas de enfrentamento na judicialização da saúde, estão incluídos os princípios da saúde baseada em evidência. Métodos: Este estudo foi conduzido de acordo com a metodologia do Instituto Joanna Briggs para revisões de escopo. Os participantes por si só não foram um critério de inclusão relevante, o conceito foi a judicialização da saúde; fenômeno caracterizado pelo processo em que os indivíduos recorrem ao sistema judicial para ter acesso a medicamentos e outros bens e serviços de saúde. O termo “estratégia” aqui adotado significa qualquer atividade, ação, prática, diretriz implementada por instituições públicas ou privadas de saúde, bem como por autoridades de saúde, governo e judiciário, que teve como objetivo racionalizar os efeitos negativos da judicialização. Em relação ao contexto, foram considerados os sistemas de saúde público e privado. Estratégias de busca foram criadas e adaptadas às seguintes bases de dados eletrônicas de saúde: Embase (via Elsevier), Medline (via PubMed) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (via Biblioteca Virtual da Saúde), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus e Google Acadêmico. Resultados: Com a remoção das duplicatas pelo software Endnote 11148 estudos tiveram o título e/ou resumo avaliados por dois revisores quando aos critérios de elegibilidade, 121 foram selecionados para leitura na íntegra, destes 79 estudos foram incluídos nesta revisão. Apenas três estudos envolveram estratégias no contexto público e privado, os demais abordam apenas os sistemas de saúde no contexto público. Nenhum dos estudos incluídos abordou os preceitos da saúde baseada em evidência como estratégia de minimizar os efeitos negativos da judicialização da saúde. As estratégias adotadas pelos gestores do sistema público 3 Resumo 3 de saúde ante os desafios propostos pela judicialização da saúde se concentram, precipuamente, em três grandes linhas mestras, ou subáreas, a saber, a informação, a mediação e a cooperação. Conclusão: A judicialização da saúde é um desafio de proporções descomunais. Não há como banalizar a magnânima relevância dos direitos nela envolvidos. Tampouco se pode olvidar que, da forma como vem se manifestando, o fenômeno projeta incontestável risco de levar ao colapso todo o sistema. Gerenciar essa crise exige, dos atores envolvidos no processo, de modo geral, e do gestor de saúde, em particular, acesso a informação adequada, e a técnicas de mediação de conflitos e de cooperação que permitam estabelecer um diálogo em permanente sintonia não apenas com os legítimos interesses de postulações cientificamente embasadas, mas também com as possibilidades reais do sistema.
Introduction: The judicialization of health is a phenomenon characterized by the process in which the individuals resort to the legal system to have access to medicines and health means and services. Objectives: The objective of this review was to map the strategies in Brazil devised by health systems, as well as the health government and judicial authorities to cope with the judicialization phenomenum, in order to rationalize public expenditures and financial aspects associated. We also verified if in these strategies the precepts of evidence-based health (EBH) have been reinforced. Methods: This review was conducted according to Joanna Briggs Institute’s methodology for scoping review. Participants per se are not a relevant inclusion criterion. The concept was the judicialization of health. We identified strategies in the context of public and private health systems used by health systems, as well as the health government and judicial authorities to rationalize the negative effects of the judicialization. The term “strategy” adopted here means any activity, action, practice, guideline implemented by public or private health institutions, as well as by health, government, and judiciary authorities, who objective was to rationalize public expenditures and financial aspects associated. Search strategies were created and adapted to the following health electronic data bases: Embase (by Elsevier), Medline (by PubMed), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and Google Scholar. Results: The search strategies yielded different studies, and after removing duplicates, 11148 studies remained. We selected 121 studies that had a high probability of meeting our inclusion criteria for a complete examination, and 79 studies were included in this review. Three studies considered the strategies in the contex of private and public systems, the remaining studies applied strategies only in the context of public health system. None of the studies included used the principles of EBH health to minimize the negative effects of health judicialization. The strategies adopted by health system concentrate, mainly, in three great primary approaches: information, mediation and cooperation. Conclusion: The judicialization of health is a challenge of great proportions. Trivialization is out of question, especially because of the great magnitude of the rights involved. Nor we can deny that the way it has been presently conducted, the phenomenon projects undeniable risk of bringing the whole system to collapse. Managing this crisis demands, from the individuals integrated in the process, overall, and from the health manager, especially, access to accurate information, conflict mediation and techniques of cooperation to provide a dialogue in perfect tuning, not only with the scientific theoretical conceptions, but also with the system’s real possibilities.
Introduction: The judicialization of health is a phenomenon characterized by the process in which the individuals resort to the legal system to have access to medicines and health means and services. Objectives: The objective of this review was to map the strategies in Brazil devised by health systems, as well as the health government and judicial authorities to cope with the judicialization phenomenum, in order to rationalize public expenditures and financial aspects associated. We also verified if in these strategies the precepts of evidence-based health (EBH) have been reinforced. Methods: This review was conducted according to Joanna Briggs Institute’s methodology for scoping review. Participants per se are not a relevant inclusion criterion. The concept was the judicialization of health. We identified strategies in the context of public and private health systems used by health systems, as well as the health government and judicial authorities to rationalize the negative effects of the judicialization. The term “strategy” adopted here means any activity, action, practice, guideline implemented by public or private health institutions, as well as by health, government, and judiciary authorities, who objective was to rationalize public expenditures and financial aspects associated. Search strategies were created and adapted to the following health electronic data bases: Embase (by Elsevier), Medline (by PubMed), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and Google Scholar. Results: The search strategies yielded different studies, and after removing duplicates, 11148 studies remained. We selected 121 studies that had a high probability of meeting our inclusion criteria for a complete examination, and 79 studies were included in this review. Three studies considered the strategies in the contex of private and public systems, the remaining studies applied strategies only in the context of public health system. None of the studies included used the principles of EBH health to minimize the negative effects of health judicialization. The strategies adopted by health system concentrate, mainly, in three great primary approaches: information, mediation and cooperation. Conclusion: The judicialization of health is a challenge of great proportions. Trivialization is out of question, especially because of the great magnitude of the rights involved. Nor we can deny that the way it has been presently conducted, the phenomenon projects undeniable risk of bringing the whole system to collapse. Managing this crisis demands, from the individuals integrated in the process, overall, and from the health manager, especially, access to accurate information, conflict mediation and techniques of cooperation to provide a dialogue in perfect tuning, not only with the scientific theoretical conceptions, but also with the system’s real possibilities.
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Palavras-chave
Direito à saúde, Judicialização da saúde, Ações judiciais, Right to health, Health judicialization, Judicial actions