The judicialisation of health in Brazil: a huge challenge that calls for innovative solutions

ID: 

147

Session: 

Poster session 1

Date: 

Sunday 16 September 2018 - 12:30 to 14:00

All authors in correct order:

Pachito DV1, Riera R1, Petramale CA2, Gadelha MIP2, Hossepian Junior A3, Atallah AN1
1 Cochrane Brazil, Brazil
2 Ministry of Health, Brazil
3 National Council of Justice, Brazil
Presenting author and contact person

Presenting author:

Daniela Pachito

Contact person:

Daniela Pachito
Abstract text
Background:
In Brazil in 2016 there were over 1,300,000 health-related lawsuits, which represents an increase of 47% in a one-year period.

Objectives:
To describe an initiative of the National Justice Council and the Ministry of Health of Brazil, supported by Cochrane Brazil and other HTA (Health Technology Assessment) centres, to facilitate evidence-based decision-making for health-related lawsuits across the nation.

Methods:
Efforts to facilitate health-related decision-making using the principles of evidence-based health care have been strengthened by the creation of other HTA centres. Some of these are now partners with Cochrane Brazil in this endeavor. Recently, the National Justice Council and the Ministry of Health of Brazil have agreed to maximize efforts. Firstly, the Núcleo de Avaliação de Tecnologias de Saúde (NATS) will closely collaborate with healthcare professionals working at the level of judicial jurisdiction, who are in charge of providing technical elements for decision-making. This will provide high-quality and continuous training for these professionals. Secondly, e-NatJus has been created: a centralized database of technical reports on technologies that repeatedly lead to health-related judicialisation. The aim of e-NatJus is to reduce duplication of effort in analyzing subjects that have previously been the focus of investigation, and also to speed up the process of responding to judicial demands. E-NatJus will be available for consultation by judges and professionals involved in decision-making.

Results:
Technical reports are included in e-NatJus. Over 50 technical reports were prepared by the HTA centres. These technical reports were developed to conform with best practice for conducting systematic reviews. Methods for promoting the collaboration of HTA centres with healthcare professionals working at the level of judicial jurisdictions are being refined and will be implemented in the near future.

Conclusions:
These strategies aim to increase the effectiveness of decision-making in the context of health-related judicialisation.

Patient or healthcare consumer involvement:
From the individual perspective, decision-making based on the best available evidence reduces the risk that ineffective or potentially harmful interventions are used. From the societal perspective, it brings better utilization of resources and better value for money.

Relevance to patients and consumers: 

In Brazil, a growing number of judicial demands have been observed; despite the efforts of the commission instituted by the Unified Health System (CONITEC) in charge of making recommendations related to the incorporation of health technologies. The decision making for such lawsuits should be founded in the best available scientific evidence. From the individual perspective, decision making based on the best available evidence reduces the risk that ineffective or potentially harmful interventions are supplied. From the societal perspective, it brings better utilization of resources and better value for money.