title: The Judicialization of Health and the Quest for State Accountability: Evidence from 1,262 Lawsuits for Access to Medicines in Southern Brazil.
abstract: The impact of increasing numbers of lawsuits for access to medicines in Brazil is hotly debated. Government officials and scholars assert that the "judicialization of health" is driven by urban elites and private interests, and is used primarily to access high-cost drugs. Using a systematic sample of 1,262 lawsuits for access to medicines filed against the southern Brazilian state of Rio Grande do Sul, we assess these claims, offering empirical evidence that counters prevailing myths and affirms the heterogeneity of the judicialization phenomenon. Our findings show that the majority of patient-litigants are in fact poor and older individuals who do not live in major metropolitan areas and who depend on the state to provide their legal representation, and that the majority of medicines requested were already on governmental formularies. Our data challenge arguments that judicialization expands inequities and weakens the universal health care system. Our data also suggest that judicialization may serve as a grassroots instrument for the poor to hold the state accountable. Failing to acknowledge regional differences and attempting to fit all data into one singular narrative may be contributing to a biased interpretation of the nature of judicialization, and limiting the understanding of its drivers, consequences, and implications at local levels.
authors: Susan Dod Brown Professor of Anthropology and Woodrow Wilson School Faculty Associate, Princeton University, Princeton, USA.
authors: João
authors: J
authors: Biehl
authors: Doctoral Candidate at the Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors: Mariana P
authors: MP
authors: Socal
authors: Visiting Lecturer of Public and International Affairs at the Woodrow Wilson School, Princeton University, Princeton, USA.
authors: Joseph J
authors: JJ
authors: Amon
mesh_terms: D001938:Brazil; D018954:Drugs, Essential / Q000600:supply & distribution*; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006806:Human Rights; D006801:Humans; D007603:Jurisprudence; D012941:Social Responsibility
chemical_list: D018954:Drugs, Essential