scholarly journals Institutional Strategies as a Mechanism to Rationalize the Negative Effects of the Judicialization of Access to Medicine in Brazil

2020 ◽  
Author(s):  
Virginia Oliveira Chagas ◽  
Mércia Pandolfo Provin ◽  
Pedro Augusto Prado Mota ◽  
Rafael Alves Guimarães ◽  
Rita Goreti Amaral
Keyword(s):  
Health Assessment ◽  
Access To Medicines ◽  
Executive Branch ◽  
The State ◽  
Negative Effects ◽  
Significance Level ◽  
Goods And Services ◽  
The Social ◽  
Institutional Strategies ◽  
Universal Health

Abstract Background Recently, the Executive Branch and Judiciary in Brazil increased spending due to larger numbers of lawsuits that forced the State to provide health goods and services. This phenomenon, known as health judicialization, has created challenges and required the Executive Branch and Judiciary to create institutional strategies such as technical chambers and departments to reduce the social, economic and political distortions caused by this phenomenon. This study aims to evaluate the effects of two institutional strategies deployed by a Brazilian municipality in order to cope with the economic, social and political distortions caused by the phenomenon of health judicialization regarding access to medicines. Methods A longitudinal study was carried out in a capital in the Central-West Region of Brazil. A sample of 511 lawsuits was analyzed. The variables were placed into three groups: the sociodemographic characteristics and the plaintiffs’ disease, the characteristics of the claimed medical products and the institutional strategies. To analyze the effect of the interventions on the total cost of the medicines in the lawsuits, bivariate and multivariate linear regressions with variance were performed. For the categorical outcomes, Poisson regressions were performed with robust variance, using a significance level of 5%. Results A reduction in the costs of medicines in the lawsuits and of the requests for medicines within the SUS formulary was verified after the deployment of the Department of Assessment of Nonstandardized Medicines (DAMNP) and the Technical Chamber of Health Assessment (CATS); an increase in processed prescriptions from the Brazilian Universal Health System was observed after the deployment of the CATS; and an increase in medicines outside the SUS formulary without a therapeutic alternative was verified after the CATS. Conclusion The institutional strategies deployed were important tools to reduce the high costs of the medicines in the lawsuits. In addition, they represented a step forward for the State, provided a benefit to society and indicated a potential path for the health and justice systems of other countries that also face problems caused by the judicialization of health.

scholarly journals INSTITUTIONAL STRATEGIES AS A MECHANISM TO RATIONALIZE THE NEGATIVE EFFECTS OF JUDICIALIZATION OF ACCESS TO MEDICINE IN BRAZIL

2019 ◽  
Author(s):  
Virginia Oliveira Chagas ◽  
Mércia Pandolfo Provin ◽  
Pedro Augusto Prado Mota ◽  
Rafael Alves Guimarães ◽  
Rita Goreti Amaral
Keyword(s):  
Health Assessment ◽  
Access To Medicines ◽  
Executive Branch ◽  
The State ◽  
Negative Effects ◽  
Significance Level ◽  
Goods And Services ◽  
The Social ◽  
Institutional Strategies ◽  
Universal Health

Abstract Background: Recently, the Executive Branch and Judiciary in Brazil increased spending due to larger numbers of lawsuits that forced the State to provide health goods and services. This phenomenon, known as health judicialization, has created challenges and required the Executive Branch and Judiciary to create institutional strategies such as technical chambers and departments to reduce the social, economic and political distortions caused by this phenomenon. This study aims to evaluate the effects of two institutional strategies deployed by a Brazilian municipality in order to cope with the economic, social and political distortions caused by the phenomenon of health judicialization regarding access to medicines. Methods: A longitudinal study was carried out in a capital in the Central-West Region of Brazil. A sample of 511 lawsuits was analyzed. The variables were placed into three groups: the sociodemographic characteristics and the plaintiffs’ disease, the characteristics of the claimed medical products and the institutional strategies. To analyze the effect of the interventions on the total cost of the medicines in the lawsuits, bivariate and multivariate linear regressions with variance were performed. For the categorical outcomes, Poisson regressions were performed with robust variance, using a significance level of 5%. Results: A reduction in the costs of medicines in the lawsuits and of the requests for medicines within the SUS formulary was verified after the deployment of the Department of Assessment of Non-Standardized Medicines (DAMNP) and the Technical Chamber of Health Assessment (CATS); an increase in processed prescriptions from the Brazilian Universal Health System was observed after the deployment of the CATS; and an increase in medicines outside the SUS formulary without a therapeutic alternative was verified after the CATS. Conclusion: The institutional strategies deployed were important tools to reduce the high costs of the medicines in the lawsuits. In addition, they represented a step forward for the State, provided a benefit to society and indicated a potential path for the health and justice systems of other countries that also face problems caused by the judicialization of health.

scholarly journals Institutional Strategies as a Mechanism to Rationalize the Negative Effects of the Judicialization of Access to Medicine in Brazil

2020 ◽  
Author(s):  
Virginia Oliveira Chagas ◽  
Mércia Pandolfo Provin ◽  
Pedro Augusto Prado Mota ◽  
Rafael Alves Guimarães ◽  
Rita Goreti Amaral
Keyword(s):  
Health Assessment ◽  
Access To Medicines ◽  
Executive Branch ◽  
The State ◽  
Negative Effects ◽  
Significance Level ◽  
Goods And Services ◽  
The Social ◽  
Institutional Strategies ◽  
Universal Health

Abstract Background: Recently, the Executive Branch and Judiciary in Brazil increased spending due to larger numbers of lawsuits that forced the State to provide health goods and services. This phenomenon, known as health judicialization, has created challenges and required the Executive Branch and Judiciary to create institutional strategies such as technical chambers and departments to reduce the social, economic and political distortions caused by this phenomenon. This study aims to evaluate the effects of two institutional strategies deployed by a Brazilian municipality in order to cope with the economic, social and political distortions caused by the phenomenon of health judicialization regarding access to medicines. Methods: A longitudinal study was carried out in a capital in the Central-West Region of Brazil. A sample of 511 lawsuits was analyzed. The variables were placed into three groups: the sociodemographic characteristics and the plaintiffs’ disease, the characteristics of the claimed medical products and the institutional strategies. To analyze the effect of the interventions on the total cost of the medicines in the lawsuits, bivariate and multivariate linear regressions with variance were performed. For the categorical outcomes, Poisson regressions were performed with robust variance, using a significance level of 5%. Results: A reduction in the costs of medicines in the lawsuits and of the requests for medicines within the SUS formulary was verified after the deployment of the Department of Assessment of Nonstandardized Medicines (DAMNP) and the Technical Chamber of Health Assessment (CATS); an increase in processed prescriptions from the Brazilian Universal Health System was observed after the deployment of the CATS; and an increase in medicines outside the SUS formulary without a therapeutic alternative was verified after the CATS. Conclusion: The institutional strategies deployed were important tools to reduce the high costs of the medicines in the lawsuits. In addition, they represented a step forward for the State, provided a benefit to society and indicated a potential path for the health and justice systems of other countries that also face problems caused by the judicialization of health.

scholarly journals Institutional strategies as a mechanism to rationalize the negative effects of judicialization of access to medicine in brazil

2019 ◽  
Author(s):  
Virginia Oliveira Chagas ◽  
Mércia Pandolfo Provin ◽  
Pedro Augusto Prado Mota ◽  
Rafael Alves Guimarães ◽  
Rita Goreti Amaral
Keyword(s):  
Health Assessment ◽  
Access To Medicines ◽  
Executive Branch ◽  
The State ◽  
Negative Effects ◽  
Significance Level ◽  
Goods And Services ◽  
The Social ◽  
Institutional Strategies ◽  
Universal Health

Abstract Recently, the Executive Branch and Judiciary in Brazil increased spending due to larger numbers of lawsuits that forced the State to provide health goods and services. This phenomenon, known as health judicialization, is related to flaws in policies and to insufficient funds available for the State to meet every demand, and it has created challenges. These challenges required the Executive Branch and Judiciary to create institutional strategies such as technical chambers and departments to reduce the social, economic and political distortions caused by this phenomenon. This study aims to evaluate the effects of two institutional strategies deployed by a Brazilian municipality in order to cope with the economic, social and political distortions caused by the phenomenon of health judicialization regarding access to medicines. A longitudinal study was carried out in a capital in the Central-West Region of Brazil. A sample of 511 lawsuits was analyzed. The variables were placed into three groups: the sociodemographic characteristics and the plaintiffs’ disease, the characteristics of the claimed medical products and the institutional strategies. To analyze the effect of the interventions on the total cost of the medicines in the lawsuits, bivariate and multivariate linear regressions with variance were performed. For the categorical outcomes, Poisson regressions were performed with robust variance, using a significance level of 5%. A reduction in the costs of medicines in the lawsuits and of the requests for medicines within the SUS formulary was verified after the deployment of the Department of Assessment of Non-Standardized Medicines (DAMNP) and the Technical Chamber of Health Assessment (CATS); an increase in processed prescriptions from the Brazilian Universal Health System was observed after the deployment of the CATS; and an increase in medicines outside the SUS formulary without a therapeutic alternative was verified after the CATS. The institutional strategies deployed were important tools to reduce the high costs of the medicines in the lawsuits. In addition, they represented a step forward for the State, provided a benefit to society and indicated a potential path for the health and justice systems of other countries that also face problems caused by the judicialization of health.

How Mobilization Type Shapes Dalit Welfare

2019 ◽  
pp. 153-176
Author(s):  
Amit Ahuja
Keyword(s):  
State Level ◽  
The State ◽  
Democratic Accountability ◽  
Negative Effects ◽  
Welfare Provision ◽  
Goods And Services ◽  
Social Sphere ◽  
The Social ◽  
Electoral Mobilization

When the social mobilization and electoral mobilization of the marginalized occur, they represent their political assertion. Why, then, should we care about the type of collective action that mobilizes the marginalized? This chapter argues that variation in welfare provision at the state level turns on a distinction in types of mobilization. When Dalits act collectively as a bloc, this has different consequences for the social sphere as compared to the electoral sphere. In the social sphere, bloc behavior articulates demands, pressurizes bureaucrats and politicians, and monitors the quality of goods and services provided by the state. Democratic accountability is increased. In the electoral sphere, however, bloc behavior has two especially negative effects. First, it transforms Dalits into weak clients, and second, it increases the probability welfare schemes will be disrupted or dismantled with electoral transfers of power. Democratic accountability is decreased.

The Autonomy-Representation Dilemma: Indigenous Groups and Distributive Benefits in the Americas

2021 ◽  
pp. 1-22
Author(s):  
Christopher L. Carter
Keyword(s):  
Public Goods ◽  
Political Representation ◽  
Capacity Constraints ◽  
The State ◽  
Negative Effects ◽  
Native Communities ◽  
Goods And Services ◽  
Indigenous Groups ◽  
Original Survey ◽  
National Governments

Abstract Autonomy carries the promise of resolving longstanding distributive inequalities between indigenous and non-indigenous groups. Yet, contemporary autonomy arrangements have often been associated instead with a reduction in native communities' access to needed public goods and services. I situate these negative effects within a broader autonomy-representation dilemma: autonomy provides indigenous groups with more responsive coethnic leaders, but these leaders frequently face difficulties in collecting and deploying revenue. These capacity constraints often arise from the way national governments have recognized autonomy. As such, pursuing coethnic representation within the state might—under certain conditions—be more likely to provide indigenous groups with needed goods and services. Drawing on natural experimental evidence and an original survey of indigenous community presidents from Peru, I first demonstrate that achieving coethnic political representation within the state can expand indigenous groups' access to the public good they most need: water. I then illustrate how capacity constraints that arise from autonomy have prevented native groups in Bolivia's autonomous municipalities from achieving similar distributive gains. Ultimately, the findings provide insights for understanding the sources of—and potential institutional remedies for—indigenous groups' unequal access to local public goods in the Americas and beyond.

scholarly journals The new doctrine on misuse of power under Article 18 ECHR: Is it about the system of contre-pouvoirs within the State after all?

2020 ◽  
Vol 38 (2) ◽  
pp. 134-155
Author(s):  
Aikaterini Tsampi
Keyword(s):  
Human Rights ◽  
Case Law ◽  
Executive Branch ◽  
The State ◽  
European Convention ◽  
The Social ◽  
Legislative Branch

The case-law on Article 18 of the European Convention on Human Rights has been evolving recently in a dramatic fashion. This evolution, which shaped a new doctrine on the misuse of power, focuses on the criminalisation of dissent within a State where undemocratic tendencies arise. The purpose of this article is to highlight these undemocratic tendencies and demonstrate that Article 18 ECHR addresses the systemic deficiencies in the balance of powers within a State. A violation of Article 18 ECHR occurs when the executive branch of government male fide tries to erode the social, political and economic contre-pouvoirs within a State and when the institutional contre-pouvoirs, namely the judicial and the legislative branch of government, fail to avert this erosion.

The Demilitarization of the Egyptian Cabinet

1982 ◽  
Vol 14 (2) ◽  
pp. 203-225 ◽  
Author(s):  
Mark N. Cooper
Keyword(s):  
Executive Branch ◽  
The State ◽  
Decision Makers ◽  
Background Characteristics ◽  
Social Scientists ◽  
Occupational Training ◽  
The Social ◽  
Class Background ◽  
Political Economic ◽  
Occupational Career

One way that social scientists categorize and describe political regimes is to analyze the nature of the executive branch of government, particularly the makeup of cabinets. The assumption is that the structure of the cabinet and the class background, and the educational or occupational training of ministers reflect the nature of the regime. Those at the top of the state may represent certain groups in society or be particularly responsive to the demands of the social groups from which they come. Background characteristics may also be a good indicator of the style of rule. Education, training, age, occupational career, all indicate how decision-makers think, how they organize to approach problems, how they issue orders and use subordinates. The institutional background of ministers may reflect the importance of various institutions in society, for the connection of institutions through individuals at the top of the state may be a good indication of which specialized constituencies must be consulted, which command power and which control political, economic, and social resources.

scholarly journals Education policies for gender equity: Probing into state responses

2013 ◽  
Vol 21 ◽  
pp. 65 ◽  
Author(s):  
Nelly P. Stromquist
Keyword(s):  
Gender Equality ◽  
Gender Equity ◽  
Social Relations ◽  
Executive Branch ◽  
The State ◽  
Educational Institutions ◽  
Education Policies ◽  
The Social ◽  
The University ◽  
State Responses

The implementation of non-discriminatory sex legislation provides theoretical and empirical grounds to examine responses by the state to gender equality. Tracing the trajectory of one such law in the U.S.—Title IX—over a period of 40 years, this study analyzes the extent to which the state: (1) acted as a unitary body, and (2) functioned to dismantle its own oppressive gender features. By examining the federal government’s three core branches (executive, legislative, and judicial), the study finds differential responses by branch, with the greatest variability expressed by the executive branch, revealing the state to be less than a coherent institution. The study also shows only modest efforts to enforce the law, raising doubts about the commitment of the state to transform the social relations of gender. The state’s framing of gender equality exclusively in terms of non-discriminatory practices falls short of fostering changes in gender mentalities and identities in U.S. educational institutions—an outcome reflected in the persistent gender clustering of fields of study at the university level.

Eurasian Economic Union: A sober look

2016 ◽  
pp. 43-60 ◽  
Author(s):  
E. Vinokurov
Keyword(s):  
The State ◽  
Customs Union ◽  
Macroeconomic Policies ◽  
Member States ◽  
Goods And Services ◽  
Eurasian Economic Union ◽  
Ongoing Work ◽  
General Rules ◽  
Economic Union ◽  
Trade And Investment

The paper appraises current progress in establishing the Customs Union and the Eurasian Economic Union (EAEU). Although the progress has slowed down after the initial rapid advancement, the Union is better viewed not as an exception from the general rules of regional economic integration but rather as one of the functioning customs unions with its successes and stumbling blocs. The paper reviews the state of Eurasian institutions, the establishment of the single market of goods and services, the situation with mutual trade and investment flows among the member states, the ongoing work on the liquidation/unification of non-tariff barriers, the problems of the efficient coordination of macroeconomic policies, progress towards establishing an EAEU network of free trade areas with partners around the world, the state of the common labor market, and the dynamics of public opinion on Eurasian integration in the five member states.

On the diversity of the effects of the state support for agriculture

2019 ◽  
pp. 59-73 ◽  
Author(s):  
Nikolai M. Svetlov ◽  
Renata G. Yanbykh ◽  
Dariya A. Loginova
Keyword(s):  
Agricultural Production ◽  
The State ◽  
Russian Regions ◽  
Negative Effects ◽  
State Support ◽  
Soft Budget Constraints ◽  
Institutional Conditions ◽  
Positive Effects ◽  
Production Factors ◽  
Corporate Farms

In this paper, we assess the effects of agricultural state support of corporate farms on their revenues from agricultural production sales in 14 Russian regions that differ in technology, environment and institutional conditions. In addition to the direct effect of the state support, the indirect effects via labor and capital are revealed. For this purpose, we identify production functions and statistical models of production factors for each of these regions separately. We find out diverse effects of the state support on revenues among the regions. Positive effects prevail. Negative effects are mainly caused by labor reductions that follow subsidy inflows. Another cause of negative effects is the soft budget constraints phenomenon.

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