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Wang D, Vasconcelos NPD, Poirier MJ, Chieffi A, Mônaco C, Sritharan L, Van Katwyk SR, Hoffman SJ. Health technology assessment and judicial deference to priority-setting decisions in healthcare: Quasi-experimental analysis of right-to-health litigation in Brazil. Soc Sci Med 2020; 265:113401. [PMID: 33250316 PMCID: PMC7769796 DOI: 10.1016/j.socscimed.2020.113401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/05/2020] [Accepted: 09/24/2020] [Indexed: 12/02/2022]
Abstract
The constitutional right to health in Brazil has entitled patients to litigate against the government-funded national health system (SUS), claiming access to various health treatments including those excluded from the health system's benefits package. Courts have tended to rely on a single medical prescription to judge these cases in favor of individual patients and against the health system. The large volume of cases has had a substantial financial impact on the government's health budget and has created unfairness in accessing healthcare. To change courts' behavior, a new health technology assessment (HTA) body - CONITEC - was created in 2011. Its creation was accompanied by an administrative procedure that made decisions about the health system's benefits package more transparent, accountable, participative and evidence-informed. It was expected that this HTA system would bring more legitimacy to the government's priority-setting decisions and promote deference from the courts. This study tests whether Brazil's new HTA system succeeded in encouraging judicial deference by analyzing a stratified random sample of 13,263 court decisions for whether the existence of a CONITEC report resulted in less frequent court orders to provide treatment for individual litigants. The results show that the creation of CONITEC did not change courts' behavior; courts still decide in favor of patients in most cases. Indeed, even when there was a CONITEC report recommending against government funding for a particular healthcare treatment, the vast majority of the relatively few patients who were unsuccessful in obtaining a health benefit at their first court hearing later obtained a favorable decision after appealing to a higher court. This finding was confirmed through an interrupted time-series analysis that did not find an impact of having a CONITEC report on courts' willingness to override a government priority-setting decision. In fact, CONITEC was rarely cited in court decisions, even when litigants mentioned the existence of a CONITEC report.
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Affiliation(s)
- Daniel Wang
- Fundação Getulio Vargas (FGV), Law School in São Paulo, Brazil.
| | | | - Mathieu Jp Poirier
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health & Osgoode Hall Law School, York University, Toronto, Canada; School of Global Health, York University, Toronto, Canada
| | - Ana Chieffi
- Deapartment of Health of the State of São Paulo, São Paulo, Brazil
| | - Cauê Mônaco
- Centro Universitário São Camilo, School of Medicine, São Paulo, Brazil
| | - Lathika Sritharan
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health & Osgoode Hall Law School, York University, Toronto, Canada
| | - Susan Rogers Van Katwyk
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health & Osgoode Hall Law School, York University, Toronto, Canada
| | - Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health & Osgoode Hall Law School, York University, Toronto, Canada; School of Global Health, York University, Toronto, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster Health Forum, McMaster University, Hamilton, Canada
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