Economic evaluation of an active search system to monitor the outcomes of health-related claims

Abstract

Objective: Economic evaluation of a scientific advisory program with the Public Defenders Office to mitigate the impacts of the judicialization on health in the municipality, as well as the implementation of an active follow-up program to monitor health outcomes arising from court demands. Methods: A two-step study, the first documental, retrospective, with data collection of lawsuits in the region of Barbalha (CE), Brazil, from 2013 to 2018, and the second stage, prospective and intervention, through mediation between the citizen and the Public Defenders Office, aiming to reduce the occurrence of the judicialization, and the monitoring of the health outcomes of the processes. The study adopted the Consolidated Health Economic Evaluation Reporting Standards protocol for economic health assessments. The data obtained from the processes were grouped and treated for characterization of the scenario. A comparison of the profile of the lawsuits in the period of 12 months before and after the installation of the program to delimit a complete fiscal cycle was carried out. Results: The advisory service promoted a decrease of 40% (p=0.01) in lawsuits. There was a 31% reduction in court costs (p=0.003), with medicines accounting for 33% of this amount. There was a decrease in inputs outside the Sistema Único de Saúde lists (27%; p=0.003), however there was no statistical difference among several demanding groups, suggesting an equanimous approach. Conclusion: Data from the initial survey were comparable to those reported in Brazil regarding the profile of judicial demands. In view of the scenario, the proposal proved feasible as a means to mitigate the costs of the judicialization through mediation. Finally, the initiative can serve as a model for adoption by municipalities that have characteristics similar to those presented in this study.

Healthcare judicialization: an analysis of indicators and official data on medications

“…Ensuring adequate patient monitoring, together with granting medication supply through judicial means, contributes to ensuring effective access to health and justice, promoting rational medication use, and avoiding potential fraud or misapplication of public resources. Monitoring health outcomes, obtaining data regarding the necessity of maintaining the benefit, and mediating the relationship between the demanding user and the judicial system can lead to around a 30% reduction in overall costs ( 28 - 29 ) .…”

“…Assegurar o adequado acompanhamento do paciente, juntamente com a concessão do fornecimento do medicamento por via judicial, colabora com a garantia do efetivo acesso à saúde e à justiça, promovendo o uso racional dos medicamentos e evitando possíveis fraudes ou má aplicação de recursos públicos. Monitorar os desfechos das demandas de saúde, obter dados relativos à necessidade ou não da manutenção do benefício e mediar a relação entre usuário demandante e sistema judiciário pode levar a uma diminuição em torno de 30% dos custos globais ( 28 - 29 ) .…”