Judicialização do acesso ao tratamento do diabetes no estado de Minas Gerais

Abstract

The main objective of this research proposal was to analyze the profile of judicial decisions on diabetes treatment against the Secretary of State of Health of Minas Gerais from October 1999 to October 2009 as well as its implications on health public policies. This is both a retrospective and descriptive study that used data about rulings on Secretary of State of Health of Minas Gerais that claimed for treatment for diabetes mellitus. We analyzed patient rulings, court proceedings, judicial representatives, defendant characteristics, description of health care procedures and the results of judicial decisions. We showed that 7.08% of all rulings claimed for benefits related to the treatment of diabetes. The first judicial decision sentenced against the state of Minas Gerais was in 2003 and since then we observe a increasing of the number of ruling up to 2009. There was a predominance of males and the age group 0 to 19 and 20 to 39 years among patient rulings. Most patient rulings lived in economically developed cities and they used to contract private lawyers to apply those judicial sentences. Most rulings requests were provided. The Secretary of State of Health of Minas Gerais was a defendant in 100% of the cases, including municipalities in 31.6% of those cases. The E10 diagnosis, diabetes insulin dependent diabetes was the most claimed in rulings with private health prescription. Medicines were the most claimed itens, i.e. Glargine Insulin. Among 63.4% of medicines were not included in the Brazilian Medicine List (RENAME). The lancets and needles were the items most claimed among all materials. The increasing in the amount of rulings caused some effects in Brazilian Health System as the incorporation of Insulin Glargine in 2005, the creation of Advisory Office in 2007, a budget dedicated to ruling claims since 2009 and the structuring of Health Judicial Decisions Office in 2014. The budget expenditure with judicial decisions reach R$ 291 million in 2013 as the same as spending on Primary Health Care. The study indicates an increase in judicial decisions on medicines and a public police improvement since rulings rates increases as well. Public policies are a way actions happens to avoid the judicial decisions growth. The research results show need to integrate health care network, considering the care of diabetes patients at all levels of attention, especially watching the actions of pharmaceutical care in the main care program for diabetes patients in Minas Gerais, currently named Hiperdia Minas. Currently, the management way toward provides claims of judicial decisions should be replied by a proactive and efficient way regarding effective public policies that could minimize the necessity of patient claims through judicial decisions. On the other hand, the Judiciary in its decisions must observe criteria such as the need to incorporate new technologies and the effectiveness of existing policies.