The Debatable Role of Courts in Brazil's Health Care System: Does Litigation Harm or Help?

Journal of Law, Medicine and Ethics

Volumn 41, Issue 1, 2013, Pages 124-137

  Prado, Mariana Mota ^a  

^a UNIVERSITY OF TORONTO   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; BRAZIL; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HUMAN; HUMAN RIGHTS; LEGAL ASPECT; POLITICS; SOCIAL CHANGE;

BRAZIL; HEALTH CARE REFORM; HEALTH POLICY; HEALTH SERVICES ACCESSIBILITY; HUMAN RIGHTS; HUMANS; POLITICS; SOCIAL CHANGE;

EID: 84876987211     PISSN: 10731105     EISSN: 1748720X     Source Type: Journal    
DOI: 10.1111/jlme.12009     Document Type: Article

References (43)

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2. Translation from the original, in Portuguese (Brazilian Federal Constitution, Art. 196. A saúde é direito de todos e dever do Estado, garantido mediante políticas sociais e econômicas que visem à redução do risco de doença e de outros agravos e ao acesso universal e igualitário às ações e serviços para sua promoção, proteção e recuperação).
3. Unlike other Constitutions, the Brazilian one does not say anything about progressive realization of this right to health.
4. A. E. Yamin and S. Gloppen, Litigating Health Rights: Can Courts Bring more Justice to Health? eds., (Cambridge: Harvard University Press, 2011): at 1.
5. D. Wilsford, "Path Dependency, or Why History Makes It Difficult but Not Impossible to Reform Health Care Systems in a Big Way," Journal of Public Policy 14, no. 3 (1994): 251-283.
6. R. Mayes, Universal Coverage: The Elusive Quest for National Health Insurance (Ann Arbor: University of Michigan Press, 2005).
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8. S. F. Haeder, "Beyond Path Dependence: Explaining Healthcare Reform and Its Consequences," Policy Studies Journal 40, no. 11 (2012): 65-86 (discussing other obstacles to change, in addition to path dependence).
9. L. D. Brown, M. Cacace, L. Frisina, and M. S. Sparer (Special Issue Editor), (presenting a series of articles that debate advantages and disadvantages of describing health care reform from a path dependence perspective). "Beyond Path Dependency: Explaining Health Care System Change," Journal of Health Politics, Policy and Law 35, no. 4 (2010).
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14. F. Hoffmann and F. Bentes, "Accountability and Social and Economic Rights in Brazil," in V. Gauri and D. Brinks, eds. (New York: Cambridge University Press, 2010): at 104-122 Courting Social Justice: Judicial Enforcement of Social and Economic Rights in the Developing World.
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16. E. Andrade, C. D. Machado, D. R. Faleiros, D. A. C. Szuster, A. A. Guerra Júnior, G. D. Silva, et al., "A Judicialização da Saúde e a Política Nacional de Assistência Farmacêutica no Brasil: Gestão da Clínica e Medicalização da Justiça," Revista Médica de Minas Gerais 18, no. 4-S4 (2008): 46-50.
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18. A. Messeder, C. Osorio-de-Castro, and V. Luiza, "Mandados Judiciais como Ferramenta para Garantia do Acesso a Medicamentos no Setor Público: A Experiência do Estado do Rio de Janeiro, Brasil," Cadernos de Saúde Pública 21, no. 2 (2005): 525-534.
19. D. Borges, Uma Análise das Ações Judiciais para o Fornecimento de Medicamentos no Mbito do SUS: O Caso do Estado do Rio de Janeiro no Ano de 2005, Master's Thesis (Fiocruz), available at (last visited February 3, 2013). http://bvssp.icict.fiocruz.br/lildbi/docsonline/3/3/1233-borgesdclm.pdf 2007.
20. L. Constantino and S. Freitas, 'Saúde em Xeque,' Folha de S. Paulo, August 1, 2005, available at (last visited February 3, 2013.). http://sistemas.aids.gov.br/imprensa/Noticias.asp?NOTCod=66473.
21. In the Brazilian legal system there is no system of precedent per se resulting in the need for every single person who wants a similar benefit to bring his or her own claim to the court. This partially explains the large volume of litigation, with multiple cases often dealing with the same set of benefits or the same kind of treatment.
22. D. Diniz, M. Medeiros and I. Schwartz, "A Tese da Judicialização da Saúde Pelas Elites: Os Medicamentos para Mucopolissacaridose," Ciência e Saúde Coletiva.
23. C. M. Flood and Y.Y. B. Chen, "Charter Rights & Health Care Funding: A Typology of Canadian Health Rights Litigation," Annals of Health Law 19, no. 3 (2010): 479-526, at note 10 (defining progressive and regressive distribution of health care resources).
24. F. S. Vieira and P. Zucchi, "Distorções Causadas pelas Ações Judiciais à Política de Medicamentos no Brasil," Revista de Saúde Pública 41, no. 2 (2007): 214-222.
25. A. Petryna, When Experiments Travel: Clinical Trials and the Global Search for Human Subjects (Princeton, NJ: Princeton University Press, 2009). (Showing how pharmaceutical companies have covered litigation costs for sick patients suffering from rare diseases to secure access to costly treatments through the courts. In some cases, courts grant access to drugs that were not approved by Brazilian regulatory agency for the health care sector (ANVISA). In other cases, courts have required the state to pay for expensive experimental drugs, using fund from the Brazilian public health care sector to cover the costs with clinical trials to test the product's efficacy).
26. M. Neri, "The Decade of Falling Income Inequality and Formal Employment Generation in Brazil," in Tackling Inequalities in Brazil, China, India and South Africa: The Role of Labour Market and Social Policies (OECD Publishing, available at (last visited February 3, 2013.). www.oecd.org/dataoecd/16/45/45284971.pdf 2010): 57-108.
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28. C. Rodríguez-Garavito and D. R. Franco, Cortes y Cambio Social: Como la Corte Constitucional transformó el desplazamiento forzado en Colombia (Bogotá: Dejusticia, 2010).
29. This may be true for all types of litigation, but right to health litigation raises special concerns about the ability of judges, instead of health experts, to be making some of these decisions, especially those that impact on allocation of scarce health resources.
30. S. J. Hoffman, "Mitigating Inequalities of Influence among States in Global Decision Making," Global Policy (Forthcoming 2012) available at (last visited February 6, 2013). http://onlinelibrary.wiley.com/doi/10.1111/j.1758-5899.2011.00153.x/abstract.
31. R. Parker, "Construindo os Alicerces para a Resposta ao HIV/AIDS no Brasil: O Desenvolvimento de Políticas sobre o HIV/AIDS, 1982-1996," Divulgação em Saúde Para Debate 27 (2003): 8-49.
32. J. C. Cohen and K. M. Lybecker, "AIDS Policy and Pharmaceutical Patents: Brazil's Strategy to Safeguard Public Health," The World Economy 28, no. 2 (2005): 211-230.
33. The Economist, May 10 2007, São Paulo. A Conflict of Goals: Helping Patients, or Science? Brazil's AIDS Programme.
34. D. Diniz, M. Medeiros and I. Schwartz, "Consequências da Judicialização das Políticas de Saúde: Custos de Medicamentos Para as Mucopolissacaridoses," Cadernos de Saúde Pública 28, no. 3 (2012): 479-489, available at (last visited February 6, 2013). http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2012000300008&lng=en&tlng=pt.
35. R. H. Mnookin and L. Kornhauser, "Bargaining in the Shadow of the Law: The Case of Divorce," The Yale Law Journal 88, no. 5 (1979): 950-997.
36. D. M. Brinks and W. Forbath, "Commentary: Social and Economic Rights in Latin America: Constitutional Courts and the Prospects for Pro-poor Interventions," Texas Law Review 89, no. 7 (2011): 1943-1956.
37. L. Forman and J. A. Singh, "The Role of Rights and Litigation in Assuring More Equitable Access to Health Care in South Africa," in C. Flood and A. Gross, eds. (Forthcoming, Cambridge University Press). The Right to Health at the Public/Private Divide: A Global Comparative Study.
38. Some of the oral presentations at the public audience are available at (last visited February 6, 2013). http://www.agu.gov.br/sistemas/site/TemplateTexto.aspx?idConteudo=94850&id_site=722&aberto=&fechado.
39. The documents submitted to the court by civil society organizations in connection with the public audience are available at (last visited February 6, 2013). http://www.stf.jus.br/portal/cms/verTexto.asp?servico=processoAudienciaPublicaSaude&pagina=Artigo.
40. C. Rodríguez-Garavito, "Beyond the Courtroom: The Impact of Judicial Activism on Socioeconomic Rights in Latin America," Texas Law Review 89 (2011): 1669-1698. In this article, Rodríguez-Garavito also discusses how different kinds of judicial remedies may account for such effects. For the latter, he distinguishes between: "strong" and "weak" judicially-pronounced rights; detailed, managerial or juristocratic decrees and open-ended, "dialogical" or collaborative ones; and the period of judicial monitoring of the implementation of decrees (extended, short, or non-existent).
41. Brazilian Supreme Court (S.T.F.), STA 175 AgR/CE-CEARÁ, Relator: Min. Gilmar Mendes, 17.3.2010, Diário da Justiça [D.J.], 30.4.2010, 4.
42. M. Taylor, Judging Policy: Courts and Policy Reform in Democratic Brazil (Stanford University Press, 2008).
43. C. Segatto, 'O paciente de R$ 800 mil', Revista Época, March 23, 2012, available at (last visited February 6, 2013). http://revistaepoca.globo.com/tempo/noticia/2012/03/o-paciente-de-r-800-mil.html.