Pharmaceutical Assistance Public Funding In A Brazilian City And Its Implications For The Universal Access To Essential Medicines

• Published in: Value in health 2017-10, Vol.20 (9), p.A658
• Main Authors: Lopes, LM, Andrade, EI
• Format: Article
• Language: English
• Subjects: Access; Appropriations; Constitutional rights; Drugs; Health care access; Health care expenditures; Health services; Investments; Pharmaceuticals; Small cities
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.08.1572

OBJECTIVES: To ensure the constitutional right to health, a national health system was created in Brazil, in 1988, appointing municipalities as the main executors of health actions and services. The universal access to basic essential medicines is cities' responsability, while the federal government and the states dispense high-end drugs. However, an alternative way to get access to public funded medicines is being consolidated: a phenomenon called "Judicialization of Health". It happens when an individual judicially claims healthcare provision. In 2015, the Health Ministry's expenditure on drugs judicialization was USD 281,704,510.00 - 8% of the federal pharmaceutical assistance budget. Since municipalities have smaller funds, this research aims to analyze judicialization's budget impact in a small Brazilian city and its implications for the universal access to essential medicines. METHODS: "Ouro Branco" was chosen due to its small populational size (estimated at 38,601 residents in 2016) and the availability of detailed expenditure records within the City Hall's website. All the medicines purchase expenses using municipal resources were analyzed for 2015 and 2016.The amount disbursed in both the universal pharmaceutical assistance policy and the drugs judicialization was calculated for each year and for the whole period. RESULTS: Ouro Branco invested USD 28,486.17 in its universal policy for the 2015-2016 period (around USD 19,000 less than established by regulation) while USD 27,991.68 were destined to judicialization. In 2015, the judiciailization expenses equated to 40% of the universal policy investment. In 2016, this ratio rose to 173%. Records show that, in 2016, all judicialization expenditure benefited only five citizens. CONCLUSIONS: Once all government levels answer to all price drugs judicialization, this phenomenon damages mostly small cities' bugets and consequently their universal pharmaceutical assistance policy. Despite judicialization is based on the "right to health" argument, it harms the right's universality when it reallocates public funds to benefit a few individuals.