Judicialização de medicamentos no VI Departamento Regional de Saúde: análise descritiva e comparativa ao Estado de São Paulo
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2022-12-19
Autores
Oliveira, Nilo Kazan de
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Universidade Estadual Paulista (Unesp)
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Introdução: A Constituição da República Federativa do Brasil de 1988 garantiu ao cidadão o direito fundamental à saúde por meio do Sistema Único de Saúde (SUS). Apesar de toda a sistemática para acesso da saúde à população, há na atualidade um número significativo de ações judiciais para fornecimento de medicamentos, o que justifica a necessidade de uma análise pormenorizada dos fatores que levam à judicialização. Objetivo: Analisar as solicitações de judicialização de medicamentos junto ao DRS VI – Bauru/SP e compará-las com a do Estado de São Paulo, considerando o município, o diagnóstico, o medicamento, a esfera e o perfil do requerente. Metodologia: Trata-se de estudo transversal retrospectivo que avaliou as solicitações de judicialização de medicamentos realizadas nos últimos cinco anos (de 2013 a 2018) nos 68 municípios pertencentes ao DRS VI por meio da análise de dados fornecidos pela Secretaria Estadual de Saúde, comparando-os em relação aos 645 municípios do Estado de São Paulo. Resultado: De um total de 149.401 demandas junto ao Estado de São Paulo, 4.453 (2,98 %) pertenceram ao DRS VI. A judicialização junto ao DRS VI foi mais prevalente nos Municípios de Bauru (30,5%); Jaú (19,7%); Brotas (12,4%); Lençóis Paulista (4,7%); Pirajuí (3,2%); Botucatu (3,2%); Barra Bonita (3,0%); Lins (2,7%); Dois Córregos (2,2%), sendo os demais 59 municípios responsáveis por 18,4%. Já no Estado, o município de São Paulo apresentou o maior número de judicializações, (21,6%), seguido de Barretos (15,3%), São José do Rio Preto (13,5%), Franca (9,8%), Ribeirão Preto (9,3%), Bauru (7,1%), Araraquara (6,8%), Presidente Prudente (6,6%), Marília (5,6%) e Sorocaba (4,4%). Bauru, o município que mais sofreu com a judicialização no DRS VI, também ocupou destaque, estando na sétima posição em relação ao Estado. Houve maior prevalência da judicialização em pessoas com idade superior a 60 anos (48,6% - DRS VI e 45,8% - Estado), e do sexo feminino (58,7% - DRS VI e 62,9% - Estado). Os medicamentos mais judicializados, foram os antidepressivos no Estado (20,8%) e imunomoduladores no DRS VI (18,2%). Os principais diagnósticos envolvidos nas judicializações de medicamentos, considerando o código internacional de doenças (CID) junto ao DRS VI foram: problemas de coração e no sistema circulatório (19,2%); 21 enfermidades que acometem o tecido conjuntivo, ósseo e muscular (18,8%); doenças mentais (15,8%); distúrbios do sistema nervoso e doenças degenerativas e inflamatórias (12,4%). No Estado houve maior prevalência de enfermidades que acometem o tecido conjuntivo, ósseo e muscular (20,1%), seguido de doenças mentais (18,1%). O acesso ao judiciário foi predominante nas varas cíveis ou da fazenda pública (75,4% - DRS VI e 98,6% - Estado), com maior prevalência de ações somente contra o Estado (71,2% - DRS VI e 68,2% - Estado). Quanto à esfera administrativa, Hospitais e Clinicas Privadas foram mais prevalentes (57% - DRS VI e 66,6% - Estado). A maioria dos medicamentos judicializados não pertencia a nenhum programa nacional de medicamentos (85,7% - DRS VI e 83,4% - Estado). A análise comparativa da judicialização dos medicamentos entre os municípios mostrou-se heterogênea. Proporcionalmente à população, houve maior judicialização nos municípios de Barra Bonita e Brotas do que em Botucatu e Bauru. No Estado, Barretos foi o que mais judicializou, mesmo possuindo população cem vezes menor que São Paulo. Conclusão: O Estado foi o ente que mais sofreu ações judiciais e a esfera administrativa mais expressiva proveniente de hospitais e clínicas privadas. Tanto no Estado de São Paulo quanto no DRS VI, houve maior prevalência da judicialização entre pessoas acima de 60 anos, do sexo feminino, sendo a vara cível e da fazenda pública a mais demandada, com medicamentos não pertencentes a um programa definido. A maior distinção ficou a cargo do CID e medicamento mais judicializados, sendo no Estado mais prevalente o acometimento da saúde mental e no DRS-VI, referente a doenças do tecido conjuntivo, ósseo e muscular e dentre os medicamentos, antidepressivos junto ao Estado de São Paulo e imunossupressores no DRS – VI. Quando normatizado pelo total de habitantes, destaca-se Botucatu no DRS-VI e Sorocaba no Estado pela menor judicialização. A análise comparativa da judicialização entre os municípios tanto do Estado como do DRS mostrou-se não homogênea, sugerindo diferentes qualidades na gestão em saúde.
Introduction: The 1988 Constitution of the Federative Republic of Brazil guaranteed citizens the fundamental right to health through the Unified Health System (SUS). Despite the entire system for accessing health care to the population, there are currently a significant number of lawsuits for the supply of medicines, which justifies the need for a detailed analysis of the factors that lead to judicialization. Objective: Analyze the requests for judicialization of medicines with the DRS VI – Bauru/SP and compare them with the State of São Paulo, considering the municipality, diagnosis, medicine, sphere and profile of the applicant. Methodology: This is a retrospective cross-sectional study that evaluated the requests for judicialization of medicines carried out in the last five years (from 2013 to 2018) in the 68 municipalities belonging to the DRS VI through the analysis of data provided by the State Health Department, comparing them to in relation to the 645 municipalities in the State of São Paulo. Data from the 10 municipalities with the highest demand for judicialization were analyzed, either from the State or from the DRS VI. Result: Of a total of 149,401 claims with the State of São Paulo, 4,453 (2.98%) belonged to DRS VI. Judicialization with the DRS VI was more prevalent in the Municipalities of Bauru (30.5%); Jaú (19.7%); Sprouts (12.4%); Lençóis Paulista (4.7%); Pirajuí (3.2%); Botucatu (3.2%); Barra Bonita (3.0%); Lins (2.7%); Two Streams (2.2%), with the remaining 59 municipalities accounting for 18.4%. In the State, the municipality of São Paulo presented the highest number of judicializations (21.6%), followed by Barretos (15.3%), São José do Rio Preto (13.5%), Franca (9.8 %), Ribeirão Preto (9.3%), Bauru (7.1%), Araraquara (6.8%), Presidente Prudente (6.6%), Marília (5.6%) and Sorocaba (4.4 %). Bauru, the municipality that suffered the most from the judicialization in the DRS VI, was also highlighted, being in seventh position in relation to the State. There was a higher prevalence of judicialization in people over 60 years old (48.6% - DRS VI and 45.8% - State), and females (58.7% - DRS VI and 62.9% - State) . The most judicialized drugs were antidepressants in the State (20.8%) and immunomodulators in DRS VI (18.2%). The main diagnoses involved in drug judicializations, considering the international code of diseases (ICD) with the DRS VI were: heart and circulatory system problems (19.2%); diseases that affect the connective, bone and muscle tissue (18.8%); mental illnesses (15.8%); nervous system disorders and degenerative and inflammatory diseases (12.4%). The other CIDs accounted for 28% of the demands. In the state, there was a higher prevalence of diseases that affect the connective, bone and muscle tissue (20.1%), followed by mental illnesses (18.1%). Access to the judiciary was predominant in civil courts or the public treasury (75.4% - DRS VI and 98.6% - State), with a prevalence of actions only against the State (71.2% - DRS VI and 68.2 % - State). As for the administrative sphere, Hospitals and Private Clinics were more prevalent (57% - DRS VI and 66.6% - State). Most of the drugs judicialized did not belong to any national drug program (85.7% - DRS VI and 83.4% - State). The comparative analysis of the judicialization of medicines between the municipalities proved to be heterogeneous. In proportion to the population, there was greater judicialization in the municipalities of Barra Bonita and Brotas than in Botucatu and Bauru. In the state, Barretos was the most judicialized, despite having a population one hundred times smaller than São Paulo. Conclusion: The State was the entity that suffered the most lawsuits and the most expressive administrative sphere from hospitals and private clinics. Both in the State of São Paulo and in the DRS VI, there was a higher prevalence of judicialization among women over 60 years of age, with the civil court and the public farm being the most demanded, with medicines not belonging to a defined program. The greatest distinction was made by the most judicialized CID and medication, with the most prevalent state that is, mental health impairment, and in DRS-VI diseases of the connective, bone and tissue tissue. and among the drugs, antidepressants in the State of São Paulo and immunosuppressants in the DRS – VI. When standardized by the total number of inhabitants, with Botucatu standing out in DRS-VI and Sorocaba in the state for the lowest prevalence judicialization. The comparative analysis of judicialization between the municipalities of both the State and the DRS proved to be nonhomogeneous, suggesting different qualities in health management.
Introduction: The 1988 Constitution of the Federative Republic of Brazil guaranteed citizens the fundamental right to health through the Unified Health System (SUS). Despite the entire system for accessing health care to the population, there are currently a significant number of lawsuits for the supply of medicines, which justifies the need for a detailed analysis of the factors that lead to judicialization. Objective: Analyze the requests for judicialization of medicines with the DRS VI – Bauru/SP and compare them with the State of São Paulo, considering the municipality, diagnosis, medicine, sphere and profile of the applicant. Methodology: This is a retrospective cross-sectional study that evaluated the requests for judicialization of medicines carried out in the last five years (from 2013 to 2018) in the 68 municipalities belonging to the DRS VI through the analysis of data provided by the State Health Department, comparing them to in relation to the 645 municipalities in the State of São Paulo. Data from the 10 municipalities with the highest demand for judicialization were analyzed, either from the State or from the DRS VI. Result: Of a total of 149,401 claims with the State of São Paulo, 4,453 (2.98%) belonged to DRS VI. Judicialization with the DRS VI was more prevalent in the Municipalities of Bauru (30.5%); Jaú (19.7%); Sprouts (12.4%); Lençóis Paulista (4.7%); Pirajuí (3.2%); Botucatu (3.2%); Barra Bonita (3.0%); Lins (2.7%); Two Streams (2.2%), with the remaining 59 municipalities accounting for 18.4%. In the State, the municipality of São Paulo presented the highest number of judicializations (21.6%), followed by Barretos (15.3%), São José do Rio Preto (13.5%), Franca (9.8 %), Ribeirão Preto (9.3%), Bauru (7.1%), Araraquara (6.8%), Presidente Prudente (6.6%), Marília (5.6%) and Sorocaba (4.4 %). Bauru, the municipality that suffered the most from the judicialization in the DRS VI, was also highlighted, being in seventh position in relation to the State. There was a higher prevalence of judicialization in people over 60 years old (48.6% - DRS VI and 45.8% - State), and females (58.7% - DRS VI and 62.9% - State) . The most judicialized drugs were antidepressants in the State (20.8%) and immunomodulators in DRS VI (18.2%). The main diagnoses involved in drug judicializations, considering the international code of diseases (ICD) with the DRS VI were: heart and circulatory system problems (19.2%); diseases that affect the connective, bone and muscle tissue (18.8%); mental illnesses (15.8%); nervous system disorders and degenerative and inflammatory diseases (12.4%). The other CIDs accounted for 28% of the demands. In the state, there was a higher prevalence of diseases that affect the connective, bone and muscle tissue (20.1%), followed by mental illnesses (18.1%). Access to the judiciary was predominant in civil courts or the public treasury (75.4% - DRS VI and 98.6% - State), with a prevalence of actions only against the State (71.2% - DRS VI and 68.2 % - State). As for the administrative sphere, Hospitals and Private Clinics were more prevalent (57% - DRS VI and 66.6% - State). Most of the drugs judicialized did not belong to any national drug program (85.7% - DRS VI and 83.4% - State). The comparative analysis of the judicialization of medicines between the municipalities proved to be heterogeneous. In proportion to the population, there was greater judicialization in the municipalities of Barra Bonita and Brotas than in Botucatu and Bauru. In the state, Barretos was the most judicialized, despite having a population one hundred times smaller than São Paulo. Conclusion: The State was the entity that suffered the most lawsuits and the most expressive administrative sphere from hospitals and private clinics. Both in the State of São Paulo and in the DRS VI, there was a higher prevalence of judicialization among women over 60 years of age, with the civil court and the public farm being the most demanded, with medicines not belonging to a defined program. The greatest distinction was made by the most judicialized CID and medication, with the most prevalent state that is, mental health impairment, and in DRS-VI diseases of the connective, bone and tissue tissue. and among the drugs, antidepressants in the State of São Paulo and immunosuppressants in the DRS – VI. When standardized by the total number of inhabitants, with Botucatu standing out in DRS-VI and Sorocaba in the state for the lowest prevalence judicialization. The comparative analysis of judicialization between the municipalities of both the State and the DRS proved to be nonhomogeneous, suggesting different qualities in health management.
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Sistema Único de Saúde, Judicialização da saúde, Gestão sanitária, Judicialization of health, Unified Health System, Health management