Judicial activism in the argentine health system: Recent trends

Health and Human Rights

Volumn 10, Issue 2, 2009, Pages 53-65

  Abramovich, Victor ^a   Pautassi, Laura ^b  

^a UNIVERSIDAD DE BUENOS AIRES   (Argentina)

^b Universidad de Buenos Aires   (Argentina)

Author keywords

[No Author keywords available]

Indexed keywords

DECENTRALIZATION; DECISION MAKING; DISPUTE RESOLUTION; HEALTH SERVICES; LEGAL SYSTEM; STRATEGIC APPROACH;

ARGENTINA; ARTICLE; ETHICS; HEALTH CARE DELIVERY; HEALTH CARE DISPARITY; HUMAN; HUMAN RIGHTS; LEGAL ASPECT; NATIONAL HEALTH SERVICE; ORGANIZATION AND MANAGEMENT; POVERTY; SOCIOLOGY; VULNERABLE POPULATION; LEGISLATION AND JURISPRUDENCE; MEDICAL SOCIOLOGY;

ARGENTINA; HEALTH SERVICES ACCESSIBILITY; HEALTHCARE DISPARITIES; HUMAN RIGHTS; HUMANS; POVERTY; SOCIOLOGY, MEDICAL; STATE MEDICINE; VULNERABLE POPULATIONS;

ARGENTINA; SOUTH AMERICA;

EID: 70449558967     PISSN: 10790969     EISSN: None     Source Type: Journal    
DOI: 10.2307/20460103     Document Type: Article

References (46)

1. The Washington Consensus referred to commonly shared themes on policy advice by Washington-based institutions that included the International Monetary Fund (IMF), the World Bank, and the U.S. Treasury Department, as these themes were relevant to economic and fiscal crises in Latin America during the 1980s. For an analysis of health reforms in Argentina, see S. Belmartino, Nuevas Reglas de Juego para la Atención Médica en la Argentina (Buenos Aires: Lugar Editorial, 1999)
2. S. Belmartino, La Reforma del Sector Salud en Argentina, in M. Rico and F. Marco (eds), Mujer y Empleo. La Reforma de la Salud y la Salud de la Reforma en Argentina (Buenos Aires: CEPAL and Siglo XXI Editores, 2006), pp. 101-150
3. J. Burijovich and L. Pautassi, Reforma Sectorial, Descentralización y Empleo en Salud en Córdoba, in Rico and Marco (Ibid.); C. Mesa Lago, Las Reformas en Salud en América Latina y el Caribe: Su Impacto en los Principios de la Seguridad Social. Documento de Proyectos (Santiago de Chile: CEPAL)
4. O. Parra Vera, El Derecho a la Salud en la Constitución, la Jurisprudencia y los Instrumentos Internacionales (Bogotá: Defensoría del Pueblo, 2003)
5. L. Pautassi, El Empleo en Salud en Argentina. La Sinergia entre Calidad del Empleo y Calidad de la Atención, in Rico and Marco, Mujer y Empleo. La Reforma de la Salud y la Salud de la Reforma en Argentina, pp. 193-233.
6. See V. Gauri and D. Brinks, Rights-Based Approach to Social and Economic Policy in Developing Countries: Law, Politics and Impact, in V. Gauri and D. Brinks (eds), The Impact of Litigation for Claiming Economic and Social Rights (Cambridge, UK: Cambridge University Press, 2007).
7. Reliable statistics do not exist on the number of judicial health rights cases in the country. In apresentation before the Inter-American Commission of the OAS in March 2002, the Ministry of Health indicated that, between December 1, 2001 and the end of February 2002, 200 appeals for relief due to suspended medicine supply were presented in the city of Buenos Aires alone. (Source: Centro de Documentación, Centro de Estudios Legales y Sociales- CELS). This information has to do with a specific case that led to an escalation in justicialization at the height of the 2001-2002 economic and political crisis. An as-yet unpublished investigation underway by Paola Bergallo, researcher at the Universidad de San Andrés, reported in the legal magazines, La Ley and Jurisprudencia Argentina, and in Supreme Court records that the total number of rulings on the right to health ascends to 460 judgments between 1987 and 2007, excluding medical malpractice suits (personal communication with the author).
8. For an expanded version of this article, see V. Abramovich and L. Pautassi, El Derecho a la Salud en los Tribunals: Algunos Efectos del Activismo Judicial Sobre el Sistema de Salud en Argentina, Salud Colectiva 4/3 (2008), pp. 261-282. Available at http://www.unla.edu.ar/public/saludColectivaNue-vo/publicacion12/pdf/2.pdf, revised for Health and Human Rights with the permission of Salud Colectiva.
9. The 1853 Constitution was successively reformed in 1860, 1866, 1898, 1949 (never entered into force), 1957, and finally, in 1994. In the last ver-sion, 11 covenants and international human rights treaties were incorporated with constitutional status (Section 75, para. 22).
10. Constitution of the Argentine Nation, First Part, Chapter One, art. 14 bis. Available at http://www. argentina.gov.ar/argentina/portal/documentos/constitucion_ingles.pdf.
11. Currently the only way to analyze coverage is through the data of the Permanent Survey of Homes (Encuesta Permanente de Hogares - EPH) of the Institute of Statistics and Census (INDEC), with urban coverage centered in provincial capitals and large urban centers, which shows a recovery in levels of access to coverage in paid health services, but this coverage remains below the 1991 level. Access to coverage in paid health services shows gaps in coverage by income levels: despite improvement in the last three years, almost seven of every ten women between 15 and 49 years of age who live in the poorest homes do not have health coverage, indicating an increase in inequality between the poorest and riches quintiles (Equipo Latinoamericano de Justicia y Género [ELA], Informe sobre Derechos Humanos de las Mujeres [Buenos Aires: ELA, 2008]).
12. Available at http://www.argentina.gov.ar/argentina/portal/documentos/constitucion_ingles.pdf (pg. 5).
13. C. Courtis, La Aplicación de Tratados e Instrumentos Internacionales Sobre Derechos Humanos y la Protección Jurisdiccional del Derecho a la Salud: Apuntes Críticos, in V. Abramovich, A. Bovino, and C. Courtis (eds), La Aplicación de los Tratados de Derechos Humanos en el Ámbito Local. La Experiencia de Una Década (1994-2005) (Buenos Aires: Ed. del Puerto, 2007), pp 281-318.
14. Committee on Economic, Social and Cultural Rights (CESCR), General Comment No. 14, The Right to the Highest Attainable Standard of Health, UN Doc. No. E/C.12/2000/4 (2000), para. 43, emphasizes that fulfillment of the minimal content is mandatory and is not subject to exceptions, not even in emergency situations; compare CESCR, General Comment No. 3, The Nature of States Parties' Obligations, UN Doc. No. E/C.12/1991/23 (1990).
15. International Covenant on Economic, Social and Cultural Rights, Article 12. Available at http://www.unhchr.ch/html/menu3/b/a_cescr.htm.
16. Available at http://www2.ohchr.org/english/bodies/cescr/docs/statements/E.C.12.2001.15HRIntel-property.pdf (pg. 5).
17. Data are from the Ministry of Economy (Mecon), Department of Analysis of Government Expenditure and Social Programs, 2008.
18. Twenty hospitals that had remained in the national sector (as a result of transfer policies that had been carried out by various administrations) were transferred to provincial jurisdictions. These transitions resulted in both gains and setbacks, transforming the equitable bases that gave birth to the public system of health care in Argentina. Currently, the provinces have jurisdiction over 65% of all public hospitals, with 69% of all beds, and the municipalities have jurisdiction over 35% of the hospitals and health providers, which represents 29% of all hospital beds (Mesa Lago [see note 1, p. 171]). In 2001, the percentage of provincial govern-ment expenditure (excluding the municipalities) with respect to GDP was 2.32% and in 2006, 2.05%(Mecon [see note 12]).
19. In this section, we continue what was devel-oped in V. Abramovich and C. Courtis, Los Derechos Sociales como Derechos Exigibles (Madrid: Trotta, 2001)
20. V. Abramovich and C. Courtis, La Justiciabilidad de los Derechos Sociales en la Argentina: Algunas Tendencias, in G. Escobar (ed), Derechos Sociales y Tutela Antidiscriminatoria (Seville: Thomson-Aranzadi, Cizur Menor, forthcoming); and Courtis (see note 9).
21. This point is extremely important with respect to the focus of some policies in the sector; even more so when this was a situation that, according to Decree 578/93, would govern the public health system (Hospital Self-Management), granting public hospitals the ability to administer resources in a decentralized way. Its purpose is to identify people with coverage who recur for indigent care services in order to facilitate payment for the care received by their respective obra social, Job Risk Administrator (Administradora de riesgos del trabajo, known as ART), or pre-payment company. Strictly speaking, the strategy is part of an embryonic policy to subsidize demand, seen in some jurisdictions as programs of coverage for specific groups, which could also be legally considered as a regressive line of action with respect to the conditions of access to basic health benefits.
22. Compare Campodónico de Beviacqua, citing Consid. 16, 17 (Ana Carina v. Ministerio de Salud y Acción Social. Constitutional Court, File C.823.XXXV (October 24, 2000; Argentina).
23. Compare Campodónico de Beviacqua, citing Consid. 16, 17 (Ana Carina v. Ministerio de Salud y Acción Social. Constitutional Court, File C.823.XXXV (October 24, 2000; Argentina).
24. Compare Campodónico de Beviacqua, citing Consid. 16, 17 (Ana Carina v. Ministerio de Salud y Acción Social. Constitutional Court, File C.823.XXXV (October 24, 2000; Argentina).
25. Compare Campodónico de Beviacqua, citing Consid. 16, 17 (Ana Carina v. Ministerio de Salud y Acción Social. Constitutional Court, File C.823.XXXV (October 24, 2000; Argentina). with explicit reference to Article 2.1 of the ICESCR.
26. Compare Campodónico de Beviacqua, citing Consid. 16, 17 (Ana Carina v. Ministerio de Salud y Acción Social. Constitutional Court, File C.823.XXXV (October 24, 2000; Argentina)., with explicit reference to the doctrine established by the Committee on Economic, Social and Cultural Rights in its final observations to the Swiss Government Report of November 20 and 23, 1998 (Concluding Observations of the Committee on Economic, Social and Cultural Rights: Switzerland, UN Doc. No. E/C.12/1/Add.30, December 7, 1998).
27. 21 Compare Campodónico de Beviacqua, citing Consid. 16, 17 (Ana Carina v. Ministerio de Salud y Acción Social. Constitutional Court, File C.823.XXXV (October 24, 2000; Argentina)., with explicit reference to Articles 23, 24, and 26 of the Convention on the Rights of the Child.
28. Compare Campodónico de Beviacqua, citing Consid. 16, 17 (Ana Carina v. Ministerio de Salud y Acción Social. Constitutional Court, File C.823.XXXV (October 24, 2000; Argentina)., with explicit reference to Article 3 of the Convention on the Rights of the Child.
29. On medical coverage to a disabled child: Supreme Court, Monteserin, Marcelino c. Estado Nacional-Ministerio de Salud y Acción Social-Comisión Nacional Asesora para la Integración de Personas Discapacitadas-Servicio Nacional de Rehabilitación y Promoción de la Persona con Discapacidad, October 16, 2001 on persons with HIV/AIDS: Supreme Court, A. C. B. C. Ministerio de Salud y Acción Social s/Amparo Ley 16.986, March 19, 1999 judgment of the Attorney General of the Nation; June 1, 2000, Court decision; on unforeseen situations regarding insurance: Supreme Court, N., L. M. otra c. Swiss Medical Group, S. A., June 11, 2003 judgment of the Attorney General of the Nation, ruling by the Court, August 21, 2003; Martín, Sergio Gustavo y Otros c. Fuerza Aérea Argentina-Dirección General Bienestar Pers. Fuerza Aérea Argentina s/Amparo, October 31, 2002 opinion of the Attorney General of the Nation, June 8, 2004, decision by the Court; M. S. A. s/Materia: Previsional s/Recurso de Amparo, November 23, 2004 Similarly, the National Appeals Tribunal of Federal Administrative Litigation, Chamber II, R., R. S. c. Ministerio de Salud y Acción Social y Otro s/Amparo, October 21, 1997 National Civil Appellate Court, Chamber C, T., J. M. c. Nubial S. A., October 14, 1997 on interim relief in situations of extreme urgency: see, for example, Supreme Court, Alvarez, Oscar Juan c. Buenos Aires, Provincia de y Otro s/Acción de Amparo, July 12, 2001 Orlando, Susana Beatriz c. Buenos Aires, Provincia de y Otros s/Amparo, April 4, 2002; Díaz, Brígida c. Buenos Aires, Provincia de y Otro (Estado Nacional Ministerio de Salud y Acción Social de la Nación) s/Amparo, March 25, 2003; Benítez, Victoria Lidia y Otro c. Buenos Aires, Provincia de y Otros s/Acción de Amparo, April 24, 2003 Mendoza, Aníbal c. Estado Nacional s/Amparo, September 8, 2003; Rogers, Silvia Elena c. Buenos Aires, Provincia de y Otros (Estado Nacional) s/Acción de Amparo, September 8, 2003 Sánchez, Enzo Gabriel c. Buenos Aires, Provincia de y Otro (Estado Nacional) s/ Acción de Amparo, December 18, 2003; Laudicina, Angela Francisca c. Buenos Aires, Provincia de y Otro s/ Acción de Amparo, March 9, 2004 Sánchez, Norma Rosa c/Estado Nacional y Otro s/Acción de Amparo, May 11, 2004 The Court granted interim relief but declared itself not competent in Diéguez, Verónica Sandra y Otro c. Buenos Aires, Provincia de s/Acción de Amparo, December 27, 2002 Kastrup Phillips, Marta Nélida c. Buenos Aires, Provincia de y Otros s/Acción de Amparo, November 11, 2003 Podestá, Leila Grisel c. Buenos Aires, Provincia de y Otro s/Acción de Amparo, December 18, 2003.
30. See, among many others, Civil and Commercial Appellate Court of Bahía Blanca, Chamber II, C. y Otros c. Ministerio de Salud y Acción Social de la Provincia de Buenos Aires, September 2, 1997 (imposed treatment by a public hospital); Tribunal of Administrative Litigation of Tucumán, Chamber II, González, Amanda Esther c. Instituto de Previsión y Seguridad Social de Tucumán y Otro s/Amparo, July 15, 2002 (imposed treatment by a government obra social); Court of Appeals in Administrative and Tax Litigation of the city of Buenos Aires, Chamber II, Sociedad Italiana de Beneficencia en Buenos Aires c. GCBA s/Otras Causas, October 7, 2004; Court of Appeals in Administrative and Tax Litigation of the city of Buenos Aires, Chamber I, Centro de Educ. Médica e Invest. Clínicas Norberto Quirno c. GCBA s/ Otras Causas, June 22, 2004 (confirmed the assess-ment of legal obligations for coverage by private providers); Court of Appeals in Administrative and Tax Litigation of the city of Buenos Aires, Chamber II, Trigo, Manuel Alberto c. GCBA y Otros s/Medida Cautelar, May 12, 2002; Court of Appeals in Administrative and Tax Litigation of the city of Buenos Aires, Chamber I, Rodríguez Miguel Orlando c. GCBA s/Otros Procesos Incidentales, December 22, 2004; Court of Appeals in Administrative and Tax Litigation of the city of Buenos Aires, Chamber I, Defensoría del Pueblo de la Ciudad de Buenos Aires (non-compliance claim regarding member Brenda Nicole Deghi) c. GCBA s/Otros Procesos Incidentales, February 10, 2005 (confirmed relief imposing treat-ment by a government obra social); Court of Appeals in Administrative and Tax Litigation of the city of Buenos Aires, Chamber I, Zárate, Raúl Eduardo c. GCBA s/Daños y Perjuicios, August 21, 2002; Court of Appeals in Administrative and Tax Litigation of the city of Buenos Aires, Chamber II, Villalba de Gómez, Leticia Lilian c. GCBA (Hospital General de Agudos Franciso Santojani) y Otros s/Daños y Perjuicios, April 8, 2003; Court of Appeals in Administrative and Tax Litigation of the city of Buenos Aires, Chamber II, Echavarría, Adriana Graciela c. GCBA y Otros s/Daños y Perjuicios, April 22, 2003; Court of Appeals in Administrative and Tax Litigation of the city of Buenos Aires, Chamber I, B. L. E. y Otros c. OSBA s/Daños y Perjuicios, August 27, 2004 (granted compensation for damages produced by denial of or inappropriate medical treatment); Court of Appeals in Administrative and Tax Litigation of the city of Buenos Aires, Chamber I, Roccatagliata de Bangueses, Mercedes Lucía c. OSBA s/Otros Procesos Incidentales, June 10, 2002; Court of Appeals in Administrative and Tax Litigation of the city of Buenos Aires, Chamber I, Urtasun, Teodoro Alberto c. Instituto Municipal de Obra Social s/ Cobro de Pesos, April 22, 2004 (imposed treatment by a government obra social).
31. Supreme Court, Asociación Benghalensis y Otros c. Ministerio de Salud y Acción Social -Estado Nacional s/Amparo Ley 16.688, judgment by the Attorney General of the Nation on February 22, 1999, deci-sion by the Court on June 1, 2000.
32. The court cited Article 12 (c) of the ICESCR, Articles 4.1 and 5 of the American Convention on Human Rights, and Article 6 of the International Covenant on Civil and Political Rights.
33. Asociación Benghalensis, cit., judgment of Attorney General, Consid. X.
34. Asociación Benghalensis, cit., judgment of Attorney General, Consid. X.
35. Tribunal of Federal Administrative Litigation, Chamber IV, Viceconte, Mariela c. Estado Nacional - Ministerio de Salud y Acción Social s/Amparo Ley 16.986, June 2, 1998.
36. Supreme Court, Ramos, Marta Roxana y Otros c. Buenos Aires, Provincia de y Otros s/Amparo, March 12, 2002.
37. Supreme Court, Defensor del Pueblo c/Estado Nacional y Otra (Provincia del Chaco) s/Proceso de Conocimiento, September 18, 2007.
38. Supreme Court, Etcheverry, Roberto E. c. Omint Sociedad Anónima y Servicios, judgment of the Attorney General, December 17, 1999, decision of the Court on March 13, 2001.
39. Supreme Court, V., W. J. c. Obra Social de Empleados de Comercio y Actividades Civiles s/Sumarísimo, December 2, 2004.
40. Supreme Court, Asociación de Esclerosis Múltiple de Salta c. Ministerio de Salud -Estado Nacional s/Acción de Amparo-medida Cautelar, judgment of the Attorney General on August 4, 2003; decision by the Court on December 18, 2003.
41. Supreme Court, Hospital Británico de Buenos Aires c. Estado Nacional-Ministerio de Salud y Acción Social s/Amparo, judgment of the Attorney General, February 29, 2000; decision by the Court on March 13, 2001.
42. Supreme Court, Policlínica Privada de Medicina y Cirugía S. A. c. Municipalidad de la Ciudad de Buenos Aires, June 11, 1998.
43. Mesa Lago (see note 1) indicates, based on Pan American Health Organization (PAHO) data, that in 2002, 84% of the population under the poverty line accessed some public service, and 45% had to acquire medicine with their own resources.
44. P. Lloyd-Sherlock, "Salud, Equidad y Exclusión en América Latina: Argentina y México," Comercio Exterior 53/8 (2003), pp. 700-710.
45. On the use of courts to monitor public policies in Argentina, see V. Abramovich, Líneas de Trabajo en Derechos Económicos, Sociales y Culturales: Herramientas y Aliados, in SUR, Revista Internacional de Derechos Humanos 2/2 (2005). Available at http://www.surjournal.org/esp/index2.php.
46. Informal interviews with professionals from the legal departments of the Ministry of Health and some officials in public health areas revealed con-cern over cases of judicial findings against the state and trade union obras sociales to cover certain surger-ies, such as gastric bypass, non-essential esthetic surgeries, or certain reproductive treatments. These benefits do not fall within public coverage plans.