The Judicialization of Health and the Quest for State Accountability: Evidence from 1,262 Lawsuits for Access to Medicines in Southern Brazil

摘要

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 elitesand private interests, and is used primarily to access high-cost drugs. Using a systematic sample of 1,262lawsuits for access to medicines filed against the southern Brazilian state of Rio Grande do Sul, we assessthese claims, offering empirical evidence that counters prevailing myths and affirms the heterogeneity ofthe judicialization phenomenon. Our findings show that the majority of patient-litigants are in fact poorand older individuals who do not live in major metropolitan areas and who depend on the state to providetheir legal representation, and that the majority of medicines requested were already on governmentalformularies. Our data challenge arguments that judicialization expands inequities and weakensthe universal health care system. Our data also suggest that judicialization may serve as a grassrootsinstrument for the poor to hold the state accountable. Failing to acknowledge regional differences andattempting to fit all data into one singular narrative may be contributing to a biased interpretation of thenature of judicialization, and limiting the understanding of its drivers, consequences, and implicationsat local levels.