Judicialização de procedimentos ambulatoriais e hospitalares no Estado de Minas Gerais

Abstract

Introduction: Internationally, the Judicialization of Health is seen as a mechanism for claiming the right to healthand its linked to the right to life. In Brazil, after the Brazilian Federal Constitution in 1988, the number of processes in health grows exponentially. There are many studies about drugs judicialization, but few of them talk about ambulatory and hospital procedures. The study of these demands can amplify the scope of health cares evaluation about the difficulties care access and coverage attendance. Objective: This study investigates the lawsuits to the execution of ambulatory and hospital procedures about their coverage and accessibility, describing the profile of lawsuits against the Minas Gerais Secretary of State for Health from 1999 to 2009. Methodology: A retrospective descriptive study of the information contained in the administrative files related to the lawsuit was done. Variables were analyzed concerning about the nature of the lawsuit, the profile of beneficiaries and the characteristics of the procedures. The procedures were classified by the Unified Procedure Table, Orthotics, Prosthetics, Medicines and Specialty Materials SUS (Unified Table SUS) and the Table of Unified Terminology of Health Supplements (TUSS). The lawsuits were related to the Agreed and Integrated Plannig (PPI), the coverage indicators available at Interactional Information Network for Health (RIPSA) and the Performance Indicators (SUS IDSUS). The SPSS version 18® was used. Results: From 6112 cases, 783 (14.3%) requested 1002 procedures, 80.8% were filed from 2007 to 2009. Judicialized individual stocks predominated in 1st instance (95.5%), with requests for injunctions (98.0%). 71.0% cases were differed. The State figured as a defendant in 100% of the shares. 63% of them mentioned the Cities. The procedures were requested by 908 beneficiaries, 54.1%were male, 58.8% were over 50 years and 48.5% were retired and housewives. The Beneficiaries live mainly in macro regions Center (26.4%) and West (23.9%). From 1002 required procedures, 63.2% were classified in Table Unified SUS and only 3.1% in Table TUSS. It was observed that SUS coverage 93.5%. The groups of surgical procedures (37.2%) and of diagnostic purposes (26.6%) were predominated. Regarding the classification level of complexity, it was observed that 80.8% of clinical procedures group were medium complexity and 53.6% surgical procedures group were high complexity. The most common procedures requested were clinical admission (13.4%), Intensive Care Unitadmission (8.9%) and circulatory surgeries (11.2%). There was no correlation between the number of cases by macro region and the mark achieved in the four indicators that make up the IDSUS analyzed. The number of procedures performed analyzed was considerably higher than planned. Conclusion: This study takes up the issues of access and coverage related to the phenomenon of judicialization of health in Brazil and draws attention to the health needs that doesnt have the same priority as drug treatment. The results indicate a significant capacity for the ambulatory and hospital procedures coverage by SUS. However, the lawsuits evaluation points to emerging needs for improved access to theprocedures of medium and high complexity.