O direito à saúde abriga um feixe de atribuições, dentre elas encontra-se a assistência farmacêutica. Atualmente, as ações judiciais de medicamentos funcionam como via alternativa ao acesso pelo Sistema Único de Saúde. Este tipo de ação tem como objeto tanto os medicamentos previstos na rede pública como aqueles não incorporados ao sistema público. O presente trabalho teve como objetivo analisar a desprogramação causada pelo fornecimento de medicamentos não padronizados e consequentemente não previstos no orçamento público aprovado, sendo custeados pelos cofres públicos em razão das demandas judiciais. O trabalho aborda o tema por uma perspectiva que evidencia a lógica da Assistência Farmacêutica federal. / The right to health houses a bundle of tasks, among which is pharmaceutical care. Currently, lawsuits involving medicines work as an alternative access to the Sistema Único de Saúde. This type of legal action has as object both drugs provided in the public system and those not incorporated into the public system. This study aimed to analyze the deprogramming caused by nonstandard drug supply and therefore not included in the approved government budget, being funded by the public purse because of lawsuits. This paper addresses the issue from a perspective that emphasizes the logic of public pharmaceutical care.

Thesis (M. A.)--University of Canterbury, 2007. / Typescript (photocopy). Includes bibliographical references (leaves 156-165). Also available via the World Wide Web

O direito à saúde abriga um feixe de atribuições, dentre elas encontra-se a assistência farmacêutica. Atualmente, as ações judiciais de medicamentos funcionam como via alternativa ao acesso pelo Sistema Único de Saúde. Este tipo de ação tem como objeto tanto os medicamentos previstos na rede pública como aqueles não incorporados ao sistema público. O presente trabalho teve como objetivo analisar a desprogramação causada pelo fornecimento de medicamentos não padronizados e consequentemente não previstos no orçamento público aprovado, sendo custeados pelos cofres públicos em razão das demandas judiciais. O trabalho aborda o tema por uma perspectiva que evidencia a lógica da Assistência Farmacêutica federal. / The right to health houses a bundle of tasks, among which is pharmaceutical care. Currently, lawsuits involving medicines work as an alternative access to the Sistema Único de Saúde. This type of legal action has as object both drugs provided in the public system and those not incorporated into the public system. This study aimed to analyze the deprogramming caused by nonstandard drug supply and therefore not included in the approved government budget, being funded by the public purse because of lawsuits. This paper addresses the issue from a perspective that emphasizes the logic of public pharmaceutical care.

Através do presente estudo analisou-se as decisões judiciais proferidas pelos Tribunais Superiores do Brasil - Supremo Tribunal Federal (STF) e Superior Tribunal de Justiça (STJ) - acerca dos conflitos entre usuários e operadoras de planos de saúde, a fim de verificar se nos julgamentos tem sido considerada a necessidade de preservação do direito à saúde. Na Parte I foram apresentados os pressupostos de compreensão do setor de planos de saúde, colocando-se à disposição informações sobre as denominações e classificações adotadas, histórico de formação e atual configuração. Ainda na primeira parte dissertou-se sobre o foco escolhido para a análise jurisprudencial: o direito à saúde. Evidenciou-se o processo histórico de reconhecimento dos direitos humanos e como o direito à saúde nele se inseriu, a natureza desse direito e sua consagração na legislação internacional e brasileira. Considerada a abordagem contratual que é dada aos planos de saúde, também se discorreu, ainda que brevemente, sobre o Código de Defesa do Consumidor (Lei nº 8.078/90) e a Lei de Planos de Saúde (Lei nº 9.656/98). A pesquisa jurisprudencial, apresentada nos capítulos da Parte II, abrangeu decisões sobre conflitos entre usuários e operadoras de planos de saúde disponíveis nos endereços eletrônicos dos Tribunais Superiores até 3 de junho de 2008 - data em que a Lei de Planos de Saúde completou 10 anos. Verificou-se que o STF não analisou o mérito dos recursos que lhe foram apresentados. A fundamentação adotada para tanto tem relevância na análise do impacto das decisões dos Tribunais Superiores na efetivação do direito à saúde em planos de saúde, mas prejudicou análises complementares. Assim sendo, no capítulo 5 as decisões do STJ e do STF foram analisadas no que diz respeito ao direito à saúde, e ao capítulo seguinte reservou-se a apresentação de aspectos complementares dos Recursos Especiais (STJ), como a natureza dos conflitos, a autoria das ações e os principais procedimentos, insumos e doenças negados aos usuários / Health insurance at Justice: is the right to health being effectived? studies how the Brazilian Superior Courts judge conflicts between health insurance companies and their users/clients. The objective of the study is to investigate whether and how the right to health takes part in the sentences. In the first part of the study the specific characteristics of the health insurance sector are introduced, including its development and its nowadays configuration and data. In the second part the judments of the Superior Courts (Superior Tribunal de Justiça and Supremo Tribunal federal) are presented and analysed.

Esta dissertação tem como objetivo discutir a questão da exigibilidade do direito à saúde no Brasil e seu impacto sobre a formulação e implementação de políticas públicas (mínimo existencial x reserva do possível). Aborda-se a evolução histórica da saúde até sua consagração como direito fundamental na Constituição Brasileira de 1988. Por meio da jurisprudência formada favoravelmente à saúde, os tribunais pátrios têm assumido papel ativo na interpretação e na proteção desse direito. Várias vezes, as decisões judiciais determinam, na prática, uma redefinição das políticas públicas do Executivo. Trata-se de um contexto que vem incentivando as pessoas ao ajuizamento de ações para exigir a concretização do direito à saúde, fenômeno também conhecido como judicialização do direito à saúde. Tal ativismo se explica pelo fato de o Judiciário considerar que a ineficiência administrativa e o método de priorização da atenção à saúde revelam falhas que interferem na proteção do acesso à saúde, reconhecendo-os como verdadeiro descumprimento do dever estatal em relação a tal direito. / The current paper aims to discuss the issue of exigibility of the right to health in Brazil and their impact on the formulation and implementation of public policies (existential minimum x reserve for contingencies). In this sense, it approaches the origin of the inclusion of the right to health as a fundamental in the Brazilian Constitution of 1988. Through the jurisprudence created while ruling writs of protection, Brazilian courts have assumed an active role in interpreting and protecting those rights. On several occasions, court rulings have forced the Executive to redefine its policies. This context has led individuals to use writs to seek the realization of their right to health, a phenomenon also called judicialization of the right to health. This activism is explained by the fact that the courts regard administrative inefficiencies and prioritization processes of health services that fail to protect an individuals access, as a violation of government duties towards this right.

O fenômeno da judicialização da política tem suscitado o interesse de inúmeros pesquisadores, especialmente a partir dos efeitos produzidos pela nova configuração constitucional de 1988. No Brasil, os estudos empíricos acerca da judicialização da política têm se concentrado em dois grandes grupos: 1) na análise do Supremo Tribunal Federal e no controle concentrado de constitucionalidade e 2) na análise da judicialização que ocorre por meio da Justiça Comum em processos individuais ou coletivos que envolvem políticas públicas. Parte expressiva da bibliografia existente sobre o tema da judicialização de políticas públicas se concentra na questão do acesso à saúde, por ser essa uma área que conheceu o maior volume de ações na Justiça Comum nos últimos anos. Limitados quase sempre à análise de jurisprudência, esses estudos raramente nos dão a conhecer o comportamento do Judiciário enquanto instituição que é acionada por atores individuais, coletivos e estatais no campo da saúde. Esse trabalho pretende analisar uma das respostas institucionais do Judiciário brasileiro às crescentes demandas por assistência à saúde que chegam pela via judicial: o Fórum Nacional do Poder Judiciário para Monitoramento e Resolução das Demandas de Assistência à Saúde - Fórum da Saúde, criado por iniciativa do Conselho Nacional de Justiça (CNJ) em 2010. O objetivo principal dessa dissertação é mostrar como o processo de judicialização da saúde se desdobrou nessa iniciativa de institucionalização de uma política pública da justiça, na forma assumida pelo Fórum da Saúde. Entendemos aqui que a experiência de criação e implementação do Fórum da Saúde configura uma política pública da Justiça. Trata-se, assim, de uma política liderada por um órgão do Poder Judiciário que, valendo-se de seu caráter administrativo e não jurisdicional, chama para si a responsabilidade de organizar os termos da política pública frequentemente judicializada, enredando por essa via atores jurídicos e não jurídicos, governamentais e não governamentais em sua concepção e implementação. / The phenomenon of \"judicialization of politics\" has aroused the interest of many researchers, especially after the effects produced by the 1988 constitutional configuration. In Brazil, empirical studies about the judicialization of politics have mainly focused on two categories: 1) in the analysis of the Federal Supreme Court and in the abstract constitutional control and 2) in the analysis of the judicialization that occurs through the Common Justice in individual or collective processes that involve public policies. A significant part of the existing bibliography on the subject of the judicialization of public policies focuses on the issue of access to healthcare, given it is the area that has seen the greatest volume of actions in Common Justice in recent years. Generally limited to the analysis of jurisprudence, these studies rarely explore the behavior of the Judiciary as an institution that is driven by individual, collective and state actors in the field of healthcare. This study intends to analyze one of the institutional responses of the Brazilian Judiciary to the growing lawsuit actions that demand healthcare assistance: the National Forum of the Judiciary for Monitoring and Resolution of Health Care Claims - Health Forum, created at the initiative of the National Justice Council (CNJ) in 2010. The main objective of this dissertation is to show how the process of health judicialization has unfolded in this initiative of institutionalizing a public policy of justice, in the form assumed by the Health Forum. We argue that the experience of creating and implementing the Health Forum configures a public policies of justice. It is thus a policy led by an agency of the Judiciary which, by virtue of its administrative and non-jurisdictional nature, calls for the responsibility of organizing the terms of the often-judicialized public policy, thereby entangling legal and non-legal, governmental and non-governmental actor, in their design and implementation.

The impact of influenza pandemics is felt most greatly in developing states, where the close proximity between humans and disease vectors, weak public health surveillance systems, and poor sanitation make these states particularly vulnerable to influenza pandemics. A vaccine is the most effective intervention to minimise the spread and impact of influenza, and yet, developing states are the least likely to have timely access to a vaccine during a pandemic. According to 'The Committee on Economic, Social and Cultural Rights General Comment No. 14: the Right to the Highest Attainable Standard of Health' there is a clear positive obligation for states to provide access to vaccines during an influenza pandemic, and this obligation is not waived or depleted merely because developing states have resource constraints. There has been a proliferation of literature recently which has considered access to medicines in developing states and the right-to-health. However, there has been little exploration of this issue in respect of pandemic influenza vaccines. This research explores the manner in which developing states procure influenza vaccines during a pandemic, and determines if the current international legal mechanisms which are available to developing states can be successfully used to enhance procurement, and increase the amount of vaccine developing states can access during a pandemic, to a point where they can discharge their right-to-health obligations. In doing so, I argue that the WHO Pandemic Influenza Preparedness Framework, and the flexibilities of the TRIPS Agreement are not able to enhance the procurement of pandemic influenza vaccines by developing states, to the point where states right-to-health obligations can be said to be discharged. From this, I propose an international 'Knowledge Clearing House as a solution to the problems in procurement which are identified in this research.

O fenômeno da judicialização da política tem suscitado o interesse de inúmeros pesquisadores, especialmente a partir dos efeitos produzidos pela nova configuração constitucional de 1988. No Brasil, os estudos empíricos acerca da judicialização da política têm se concentrado em dois grandes grupos: 1) na análise do Supremo Tribunal Federal e no controle concentrado de constitucionalidade e 2) na análise da judicialização que ocorre por meio da Justiça Comum em processos individuais ou coletivos que envolvem políticas públicas. Parte expressiva da bibliografia existente sobre o tema da judicialização de políticas públicas se concentra na questão do acesso à saúde, por ser essa uma área que conheceu o maior volume de ações na Justiça Comum nos últimos anos. Limitados quase sempre à análise de jurisprudência, esses estudos raramente nos dão a conhecer o comportamento do Judiciário enquanto instituição que é acionada por atores individuais, coletivos e estatais no campo da saúde. Esse trabalho pretende analisar uma das respostas institucionais do Judiciário brasileiro às crescentes demandas por assistência à saúde que chegam pela via judicial: o Fórum Nacional do Poder Judiciário para Monitoramento e Resolução das Demandas de Assistência à Saúde - Fórum da Saúde, criado por iniciativa do Conselho Nacional de Justiça (CNJ) em 2010. O objetivo principal dessa dissertação é mostrar como o processo de judicialização da saúde se desdobrou nessa iniciativa de institucionalização de uma política pública da justiça, na forma assumida pelo Fórum da Saúde. Entendemos aqui que a experiência de criação e implementação do Fórum da Saúde configura uma política pública da Justiça. Trata-se, assim, de uma política liderada por um órgão do Poder Judiciário que, valendo-se de seu caráter administrativo e não jurisdicional, chama para si a responsabilidade de organizar os termos da política pública frequentemente judicializada, enredando por essa via atores jurídicos e não jurídicos, governamentais e não governamentais em sua concepção e implementação. / The phenomenon of \"judicialization of politics\" has aroused the interest of many researchers, especially after the effects produced by the 1988 constitutional configuration. In Brazil, empirical studies about the judicialization of politics have mainly focused on two categories: 1) in the analysis of the Federal Supreme Court and in the abstract constitutional control and 2) in the analysis of the judicialization that occurs through the Common Justice in individual or collective processes that involve public policies. A significant part of the existing bibliography on the subject of the judicialization of public policies focuses on the issue of access to healthcare, given it is the area that has seen the greatest volume of actions in Common Justice in recent years. Generally limited to the analysis of jurisprudence, these studies rarely explore the behavior of the Judiciary as an institution that is driven by individual, collective and state actors in the field of healthcare. This study intends to analyze one of the institutional responses of the Brazilian Judiciary to the growing lawsuit actions that demand healthcare assistance: the National Forum of the Judiciary for Monitoring and Resolution of Health Care Claims - Health Forum, created at the initiative of the National Justice Council (CNJ) in 2010. The main objective of this dissertation is to show how the process of health judicialization has unfolded in this initiative of institutionalizing a public policy of justice, in the form assumed by the Health Forum. We argue that the experience of creating and implementing the Health Forum configures a public policies of justice. It is thus a policy led by an agency of the Judiciary which, by virtue of its administrative and non-jurisdictional nature, calls for the responsibility of organizing the terms of the often-judicialized public policy, thereby entangling legal and non-legal, governmental and non-governmental actor, in their design and implementation.

The main objective of this thesis is to analyze the access of refugees to the right of health in Turkey. There are significant problems in the access of refugees to the available health services and there are no special health services designed to meet the needs of the refugees. Through field research in a city where refugees are settled, the problems related with the access to health services by refugees were examined. In a qualitative study design, this piece of research involved in depth interviews with health professionals, representatives of the NGOs working with refugees and refugees to understand the problems associated with the access of refugees to health services and the dynamics of the clinical encounter between the health professionals and refugees. The study has found that refugees cannot reach sufficient and appropriate health services in Turkey and their fundamental right of access to the right to health is not realized in practice. Moreover, it was found that the provision of health services is riddled with many difficulties, such as the lack of professional translators, the stereotypes common among health professionals about refugees. The legislation about health services and health insurance should be revised in a way to cover all asylum-seekers and to provide special health services for refugees such as comprehensive medical screenings on arrival and trauma and psychological counseling.

Pregnancy and motherhood are natural processes in the lives of women of reproductive age. These processes are generally considered to be positive and fulfilling experiences. However, for various reasons, many women end up dying as a result of these processes. Improving maternal health and reducing maternal mortality are accepted as human rights challenges and prioritized in several international declarations and national policies. However, progress in achieving these objectives still remains poor. This thesis aims to explore the maternal health and healthcare in the Indian state of Madhya Pradesh through a human rights lens. A human rights lens provides a framework to study various aspects of the problem of maternal health from a human rights perspective. It helps in highlighting the gaps and challenges related to political priority, sociocultural, economic and individual-level factors and the availability, accessibility, acceptability and quality of maternal healthcare services. A combination of quantitative and qualitative research methodologies was applied in four sub-studies conducted in Madhya Pradesh. The specific objectives were: to investigate, by using John W. Kingdon’s multiple-streams model of agenda setting, why and how maternal health became a political priority in the state (Paper I); to estimate the effects of individual-, community- and district-level characteristics on the utilization of maternal health services with special reference to antenatal care, skilled attendance at delivery and post-natal care (Paper II); to analyse sociocultural and service delivery related dimensions of maternal deaths in rural central India through a human rights lens (Paper III); and to evaluate the technical efficiency of the public district hospitals using data envelopment analysis (Paper IV). The findings of the first qualitative study indicated that various developments at international, national and state level brought the issue of maternal health to the priority political agenda in Madhya Pradesh state. This resulted in the introduction of new policies and programmes and more resources were allocated for improving maternal health. However, several challenges still remain in ensuring proper implementation of these programmes and policies. The quantitative study on factors affecting the use of maternal health services revealed that 61.7% of women used antenatal care at least once, 49.8% of women used skilled attendance at delivery and 37.4% of women used post-natal care during their most recent pregnancy. The household’s socio-economic status and mother’s education emerged as the most important factors associated with the use of antenatal care and skilled attendance at delivery. Delivery by skilled personnel and the use of antenatal care were the most important factors in the use of post-natal care. This study highlighted the need to identify and focus on community- and district-level intervention along with addressing the individual-level factors. The findings of the third qualitative sub-study revealed that all pregnant women in the study tried to access medical assistance for obstetric complications but various factors delayed appropriate care. The underestimation of complication symptoms by family members, gender inequity and the negative perceptions regarding delivery services deferred decisions to seek care. Transportation problems and care seeking at multiple facilities also constrained timely reaching of appropriate health facilities. Negligence by health staff in providing care, and unavailability of blood and emergency obstetric care services, delayed the receiving of adequate care after reaching a health facility. This study indicates that normative elements of a human rights approach to maternal health, i.e. availability, accessibility, acceptability and quality, were not fully upheld. The deceased women and their relatives were unable to claim their entitlements and the duty bearers could not meet their obligations despite their conscious efforts to improve maternal health. In the last study, the results of data envelopment analysis revealed that half of the district hospitals (20) in the study were operating inefficiently. This research establishes a need to give special attention to addressing challenges in the maternal health programmes at the implementation level as well as tackling the social determinants of maternal health. In order to increase the utilization of maternal health services in the state, the need to identify and focus on community- and district- as well as individual level interventions is emphasized. In order to prevent maternal deaths, a need for further concentrated efforts is underlined with a view to honouring human rights elements of maternal health by better community education, women’s empowerment and health system strengthening with the provision of appropriate and timely services including emergency obstetric care of good quality. It also highlights a need to identify the causes of the observed inefficiencies and to take appropriate measures to increase the efficiency of district hospitals.