Análise da judicialização da política de saúde no Hospital Universitário Walter Cantídio

Abstract

This work aims at analyzing the right of citizens to public health that has to be enforced by a judicial process, commonly known by judicialization, as seen in the context of the Walter Cantídio University Hospital (HUWC). It is the upshot of an evaluative research, encompassing individuals involved in judicial processes: users, managers and federal attorneys assigned to assist the poor, known in Brazil as public defenders. The analytical effort was to understand key dimensions in the configuration of the judicial phenomenon that enforces the right to health assistance: health conception; relationship between health and justice; recurring to judicial action in the context of health; users' reasons for resorting to a judicial process in their struggle to secure their rights in relation to health care; perceptions about governmental performance in the judicial processes; paths traveled by users in their search for rights through the judicial process. It is worth highlighting as fundamental concepts the following items to guide the investigative process: health, rights to health, Sanitary Reform Movement and judicialization. These concepts were elaborated based on contributions by Sarah Escorel, Jairnilson da Silva Paim, Norberto Bobbio, Maria Inês Bravo, Luís Roberto Barroso, among others. The locus of this research was the HUWC, a health care facility administered by the Brazilian Hospital Resources Company (EBSERH), part of a larger organizational structure, namely, the Federal University of Ceará. In the development of this evaluative research, in the perspective of an in-depth approach, a study of qualitative nature was carried out, as proposed by Lea Rodrigues (2008). To launch this research in the field as an in-depth evaluation, a qualitative study was developed, with quantitative contributions. In order to attend to researching requisites, some items were considered such as bibliographic research, documentary research, exploratory research and field research. Field research was done through a semi-structured interview involving users who had resorted to the judicial process, managers and public attorneys. Data of this evaluative research were analyzed under the method of Bardin’s Content Analysis (1977), systematizing analytical themes. Subjects under investigation had different conceptions regarding the themes being worked. While a significant part of users understands health under the focus of absence of disease, managers, attorneys and some users by approaching a biomedical dimension choose a broader understanding, relating it to other dimensions of life, such as food, sanitation and hygiene, thus nearing the concept defended by the Sanitary Reform. The public, managers and public attorneys recognize health as a right to be guaranteed through public policies and implemented by the State. And, when they equate health with rights, they identify in the Judiciary a favorable opportunity to guarantee its viability. In spite of this understanding, the subjects understand that the interference of the Judiciary in the area related to health compromises, to a certain extent, the functionality of the health system, since the Unified Health System (SUS) is thought for society as a whole while judicialization is directed towards an individual particular instance. Users reported that the main reason that led them to look for the Judicial System was the long time of waiting to be attended, coupled with a chronic HUWC's administrative inability to solve the problem. In this sense, users ironically were oriented mostly by the hospital’s medical staff to seek help from justice. The subjects, especially the users, had different positions regarding the work of the Judiciary in the health area. On the one hand, there are those who agree and deem this action necessary; on the other, there are those who disagree and believe that, as health is a right, there should be no need for interference from the judiciary. In specific terms of the paths taken by users to access the right to health, there is a predominant practice: they seek, initially, the means established for access to health care, with the Health Office being the main entry attempt. However, administrative procedures implemented to guarantee and organize the citizens' access to health services – the Regulation Central and its waiting list proved to be inefficient in providing a good response to the problem, within a feasible time limit, causing these subjects to seek other resources to access the services, among them, the judicialization. The study shows that it is imperative to rethink health policies in such a way that it might serve the greatest number of people, mainly through the requalification of its administrative procedures. It is necessary that the Judiciary System treat health situations in a more collective and less individualized way. It is imperative that HUWC establish internal strategies to tackle issues that routinely lead to restricting users' rights.