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Previous issue date: 2017-09-01 / A judicializa??o das pol?ticas p?blicas de sa?de ? um fen?meno contempor?neo e crescente na realidade brasileira, tendo a potencialidade de gerar impactos na gest?o p?blica, seja de forma positiva ou negativa. Nesse sentido, a presente tese buscou compreender as causas da judicializa??o e suas consequ?ncias para a gest?o p?blica na implementa??o da pol?tica de oncologia no Rio Grande do Norte. Para tanto, incorporou-se os objetivos e categorias anal?ticas da tese (falhas, causas, consequ?ncias, alternativas e evid?ncias) ao ciclo judicializado de pol?ticas p?blicas de Barreiro e Furtado (2015), adaptando-o de modo a analisar uma pol?tica p?blica federal e que tivesse a sua implementa??o regida pelo modelo top down, e fosse analisada pelas vertentes: disposi??o dos servi?os, hierarquia, comunica??o e estrutura federativa (modelo de Edwards). Dando sequ?ncias as defini??es da tese, foi escolhida a metodologia de estudo de caso, tendo como unidade anal?tica o Rio Grande do Norte, como fonte de dados: a) decis?es judiciais proferidas em segunda inst?ncia pelo Tribunal de Justi?a do Rio Grande do Norte e pelo Tribunal Regional Federal 5? regi?o, em uma an?lise hist?rica a partir de 2007 at? 2016, b) documentos de gest?o: plano estadual de sa?de, plano plurianual, plano estadual de oncologia, relat?rio anuais de gest?o e c) entrevistas a profissionais vinculados a gest?o e a execu??o da pol?tica oncol?gica no Rio Grande do Norte. Os dados foram ent?o analisados por meio da an?lise de conte?do de Bardin (2011). Os resultados revelaram que as principais causas da judicializa??o de medicamentos oncol?gicos no RN envolvem: restri??es or?ament?rias e financeiras, exist?ncia dos vazios assistenciais, inconsist?ncia com os prestadores de servi?os oncol?gicos, falta de atualiza??o dos protocolos cl?nicos envolvendo medicamentos oncol?gicos, dificuldades no diagn?stico do c?ncer e no acesso dos pacientes aos servi?os do SUS. Os medicamentos mais demandados judicialmente (2007-2016) foram: trastuzumabe, rituximabe, temozolamida, sunitinibe, bevacizumabe, bortezomide, sorafenibe e cetuximabe, sendo o c?ncer de mama e o linfoma n?o hodgkin os mais prevalentes nas decis?es. Evidenciou-se que para a gest?o p?blica, os efeitos s?o primordialmente negativos e focados no desajuste or?ament?rio e financeiro e no preju?zo na presta??o dos servi?os para a coletividade. Contudo, a presente tese, aponta alternativas poss?veis de serem aplicadas pelos entes federativos, tanto a curto prazo quanto a longo prazo, que s?o capazes de mitigar os poss?veis danos para o servi?o p?blico de sa?de, requerendo empenho de todos os envolvidos em prol do bem maior: a assist?ncia oncol?gica p?blica sendo prestada com excel?ncia e abrang?ncia, para todos que necessitam de tratamentos para o c?ncer no estado do Rio Grande do Norte. Com isso, a presente tese, subsidia a gest?o p?blica, a medida que analisa conjuntamente causas, efeitos e alternativas envolvendo a judicializa??o e a oncologia no RN, permitindo que sejam tra?adas estrat?gias para concomitantemente diminuir os efeitos negativos da judicializa??o, ampliar a capacidade de debate envolvendo os efeitos positivos e com isso expandir a implementa??o da pol?tica oncol?gica em todo estado. / The judicialization of public health policies is a contemporary and growing phenomenon in the Brazilian reality, with the potential to generate impacts on public management, whether positive or negative. In this sense, the present thesis sought to understand the causes of the judicialization and its consequences for the public management in the implementation of the policy of oncology in Rio Grande do Norte. For this purpose, the objectives and analytical categories of the thesis (failures, causes, consequences, alternatives and evidences) were incorporated into the judiciary cycle of public policies of Barreiro and Furtado (2015), adapting it in order to analyze a federal public policy and Which had its implementation governed by the top down model, and was analyzed by the following aspects: service provision, hierarchy, communication and hierarchical structure (Edwards? model). Following the definitions of the thesis, the methodology of case study was chosen, having as analytical unit the state of Rio Grande do Norte, and as data source: a) judicial decisions rendered in second instance by the Court of Justice of Rio Grande do Norte and by the 5th region Federal Regional Court, in a historical analysis from 2007 to 2016, b) management documents: state health plan, multiannual plan, state oncology plan, annual management reports and c) interviews with management professionals and Implementation of cancer policy in Rio Grande do Norte. The data were then analyzed through the content analysis of Bardin (2011). The results showed that the main causes of cancer drug treatment in the newborns include: budgetary and financial constraints, existence of care gaps, inconsistency with providers of cancer services, lack of updating of clinical protocols involving cancer drugs, difficulties in diagnosing cancer and In the patients' access to SUS services. The drugs most demanded judicially (2007-2016) were: trastuzumab, rituximab, temozolamide, sunitinib, bevacizumab, bortezomide, sorafenib and cetuximab, with breast cancer and non-hodgkin lymphoma being the most prevalent in decisions. It has been shown that, for public management, the effects are primarily negative and focused on budget and financial mismatch and the loss in the provision of services to the community. Nevertheless, this thesis points out possible alternatives to be applied by federative entities, both in the short term and in the long term, that are able to mitigate the possible damages to the public health service, requiring the commitment of all those involved in favor of the greater good: public cancer care being provided with excellence and comprehensiveness for all who need cancer treatments in the state of Rio Grande do Norte. Thus, the present thesis subsidizes public management, as it analyzes jointly the causes, effects and alternatives involving the judicialization and oncology in the NN, allowing strategies to be drawn up simultaneously to reduce the negative effects of the judicialization, to increase the capacity for debate Involving the positive effects and, therefore expanding the implementation of cancer policy throughout the state.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/24357 |
| Date | 01 September 2017 |
| Creators | Galv?o, M?rcia Fernanda Silva Macedo |
| Contributors | 21299461867, Abrucio, Fernando Luiz, 16384132826, Vieira, James Batista, 82722056020, Ara?jo, Maria Arlete Duarte de, 10344365549, Gomes, Sandra Cristina, 16669082827, Sano, Hironobu |
| Publisher | PROGRAMA DE P?S-GRADUA??O EM ADMINISTRA??O, UFRN, Brasil |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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