Why do people appeal to the courts for access to medication? The case of insulin analogues in Bahia (Brazil)

Lisboa, Erick Soares; Souza, Luis Eugenio Portela Fernandes de

doi:10.1590/1413-81232017226.33922016

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Article • Ciênc. saúde colet. 22 (6) • June 2017 • https://doi.org/10.1590/1413-81232017226.33922016 copy

Why do people appeal to the courts for access to medication? The case of insulin analogues in Bahia (Brazil)

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Insulin analogues have been the object of controversy concerning their therapeutic superiority to human insulin. Perhaps, in part, because of this, insulin analogues are frequently the subject of lawsuits. The judicialization of health has been well studied, but little is known about the reasons that lead people to go to the courts to obtain access to medicines on SUS (the Brazilian National Health System). Therefore, this study aims to analyze the reasons that led people to appeal to the courts to obtain access to insulins analogues in the state of Bahia. This is a case study based on documentary sources. Between 2010 and 2013, 149 lawsuits requiring insulin analogues from the state health authority were filed in the courts. The main reasons for the appeal to the courts, cited in the cases, can be grouped into four categories: the users’ lack of finances, an essential need for insulin analogue, the duty and obligation of the state to provide them and bureaucratic difficulties. People turned to the courts, mostly, because doctors who accompany their patients have shifted from the official policy, believing that insulin analogues are better than human insulins. They also recognize that the public health system does not distribute them nor does it give doctors the wherewithal to purchase them with their own resources.

Court decisions; diabetes mellitus; insulin; right to health

Reasons	Arguments
A lack of financial resources on the part of the plaintiff.	The plaintiffs argued that they did not have money to foot the bill for the medical fees as the insulin analogue medications were expensive or paying for such medications could put at risk the covering of their domestic expenses.
A lack of financial resources on the part of the plaintiff.	They also mentioned having to take leave from their work due to complications presented by the disease and the lack of the medication which reduced even further, their financial ability to purchase it.
Indication of the need to use insulin analogues.	Based on the prescriptions or the medical reports, they stated that the insulin distributed by SUS was not effective causing serious glycemic oscillations, severe hypoglycemia and hyperglycemia crises and it put their health at risk.
	They also affirmed that no medication for diabetes that had been made available by SUS resulted in a satisfactory therapeutic response. They highlighted that the medical report should take precedent over clinical and scientific studies.
	They added that the application of the insulin analogue in the form of a pen was less invasive which was not to do with mere convenience but was important for the health of the diabetic person.
The obligation of the state in the provision of insulin analogues.	They argued that health care is the right of everyone, as documented in the Federal Constitution.
	The fact that insulin analogues are not a part of the SUS medication does not take way the state’s duty and obligation in providing it as the right to life and dignity surpasses administrative standards.
	The Public Authority has the duty and obligation of providing medication that is essential to the health of a person in need. They must be those that are the most adequate and efficient for the preservation of the life of the diabetic person.
	The provision of health resources by the state can be viewed as the right of a consumer.
	In the actions in 2013 some plaintiffs alleged that the fact that Sesab had brought into force the Official Notice nº 1603 of 2012 that set out the criteria for the distribution of insulin analogue was to recognized the obligation to make the medication available. And the fact that the Centro de Diabetes and Endocrinologia in Bahia (Cedeba) exists, attests to the fact that Sesab is responsible for the dissemination of the treatment that is recommended by doctors.
	And the non-provision of medication is a form of negligence on the part of the state towards health care and a lack of or poor service provision which demands the intervention of the courts.
Access difficulties due to administrative or bureaucratic issues.	They justified appeals to the courts as a means to speed up the receipt of the medication as waiting on the Cedeba register could last for long periods of time.
	The residents on the outskirts of the city that took actions did not have the wherewithal to travel to the city of Salvador every month to receive their insulin.
	In twelve cases, it was noted that the administrative route was taken to obtain the medication from Sesab, but there was no success.

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[1] Collaborations

ES Lisboa contributed to setting the scope of this paper as well as: analyzing and interpreting the data, redrafting this paper and approving the final draft. LEPF de Souza contributed to setting the scope of this paper as well as: providing a critical review and approving the final draft that was published.