É possível garantir a integralidade e a universalidade da assistência farmacêutica em tempos de judicialização da saúde?

Abstract

Law 12.401/11 and Decree 7.508/11 are celebrated, among other reasons, for introducing rules to breast the judicialization of health in Brasil. This study analysis the impact of the observance of universal access to comprehensive pharmaceutical assistance criteria delimited by these regulations in Minas Gerais first decade of medicines judicialization scenario from 1999 to 2009. Its a descriptive retrospective study of investigation of drugs and prescriptions registers contained in database built by Federal University of Minas Gerais Health Economics Research Group (GPES/UFMG) related to the 6.112 deferred healthcare lawsuits in Minas Gerais from October 1999 to October 2009. Studied variables were: year, medicine RENAMEs insertion, existance of SUS logo in prescription and nature of prescriptions establishment. From the variables analysis, the judicialized medicines were classified according to their adequacy to pharmaceutical assistance criteria instituted in 2011 for each year and for the whole period. The results point that, from 10.051 selected medicines, 50,91% were included in RENAME, 7,98% were prescribed in paper containing SUS logo and 10,46% were related to healthcare establishment of public nature. Furthermore, 7,69% were classified as adequate to the criteria and 68,84% as inadequate. Due to the impossibily of classifying 23,47% of the medicines because of lack of information, a new classification was applied separately to the group of 5.580 medicines containing at least one information about the medical care. Thus, the adequacy rose to 13,85% of the medicines and the inadequacy to 85,77%. From 2003 to 2009, a decrease of lack of information about prescription was observed as well as an increase of the proportion of medicines classified as inadequate. The results make evident the dimension reached by Brazils healthcare judicialization in the end of 2000s which boosted decisions making in order to mitigate the phenomenon. The parameters for universal access to comprehensive pharmaceutical assistance established in 2011 demonstrate potential to rationalize the judicialization if obeyed by Judiciary: they would had avoided from 68,84 to 85,77% of medicines judicialization in Minas Gerais from 1999 to 2009. But the regulations are superficial interventions that end up reinforcing the reduced right to health conception as access to goods and services, assumed in judicializations context. Political and judicial decisions permeability to participation of the various involved social actors could approximate them to the universal, egalitaian and comprehensive right to health fulfilment.