Health technology assessment and judicial deference to priority-setting decisions in healthcare

Quasi-experimental analysis of right-to-health litigation in Brazil

Bibliographic Data

ID4806471
AuthorsDaniel Wei Liang Wang (0000-0002-7761-1315, Fundação Getulio Vargas, corresponding author), Daniel Wang (0000-0002-1701-739X), Natalia Pires De Vasconcelos (0000-0002-0309-6904, Insper), Mathieu Jp Poirier (0000-0003-3842-0011, York University), Ana Luiza Chieffi (0000-0001-7073-0891), Ana Chieffi, Cauê Mônaco (0000-0002-5316-2156, Centro Universitário São Camilo), Lathika Sritharan (0000-0001-9352-2956, York University), Susan Rogers Van Katwyk (0000-0002-1758-8635, York University), Steven J Hoffman (0000-0002-2064-3711, Impact)
Year2020
Volume265
Pages113401
Publication date2020-11-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2020.113401
PMID33250316
OpenAlexW3093830251
LanguageEN
Citations received4
References cited18

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

Deference · Government (linguistics · Health care · Health technology · Judicial deference · Legitimacy · Political science · Politics · Health Systems, Economic Evaluations, Quality of Life · Human Rights and Development · Law · Medicine · Public Administration · Public Health in Brazil · Health Policy

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