Judicialization of health at the level of Brazilian treatment centers: is the allocation of public resources efficient?

Abstract

Objectives: to describe the management process of judicialized drugs at the level of a tertiary hospital, evaluating their potential weaknesses and the need for interventions; 2) evaluate the sample of national scenario regarding the management of judicialized drugs, based on the aspects previously listed at the institutional level. Methods: In the institutional scenario, were analyzed the activities of provision and dispensing of these drugs, arising from 168 lawsuits, and interventions carried if there is detection of remaining vials or financial resources in the institution, through internal control spreadsheets, medical records and other institutional documents, from January 2017 to December 2018. The sample of national scenario was assessed by means of a questionnaire. Results: At the institutional level, 168 lawsuits were analyzed. The cost of medicines was US$ 5,493,361.83, and 17.3% remained in the institution as a residual of vials or financial resources related to the lawsuits of 104 patients (65.8%). A total of 116 interventions were carried out, highlighting the return to the provider source (US$ 409,701.70) and exchanges of vials to avoid loss due to expiration (US$ 140,349.24), saving public coffers US$ 853,374.04. At the national level, 80% of the centers reported the discontinuation of treatment with judicialized drugs, and all carried out actions to manage the excess of vials. Conclusion: This work demonstrated that the discontinuity or non-initiation of therapy with judicialized drugs is an important problem inherent to the judicialization of drugs in the institutional and national scenario, which generates remaining vials and/or financial resources in the institutions, contributing to the inefficient allocation of public resources.