Legal actions for children differ in the SUS and private sector – 04/12/2024 – Health

Little girl Lizzie, 1, from Cubatão (SP), is allergic to milk and can only eat infant formula. She needs 12 cans per month, which cost R$3,000, equivalent to the family’s income. The parents took legal action, and the state of São Paulo was forced to provide the food.

Rafael, 9, has been diagnosed with severe autism for two years. Faced with the lack of qualified professionals in the service indicated by the health plan, the mother went to court and managed to get the operator to reimburse the treatment at another clinic, which costs around R$10,000 per month.

The reality of these two children illustrates well the current scenario of the judicialization of children’s health in the state of São Paulo, which has a very different profile depending on whether the defendant is the SUS or the health plans.

The portrait was drawn up in a study by Insper, which analyzed 290 cases judged by the São Paulo Court of Justice between 2011 and 2022 related to petitions in the health area that had children and adolescents under the age of 18 at the forefront.

Among those who use the public health system, the actions are more inclusive. There are more black, brown and girls, more presence of public defenders and less concentration of diseases and problems that motivate legal action.

When it comes to actions against health plans, the plaintiff tends to be more male, young and white. Private lawyers also predominate (80% of cases). These causes have an average value five times higher than those in which the SUS (Unified Health System) is activated.

According to the researchers, the objective of the work was to investigate what motivations underlie the judicialization of health involving children and young people and to understand the weight of social inequalities in this phenomenon.

According to the work, the three most frequent health conditions that motivate litigation against health plans are autism spectrum disorder (ASD), which accounts for 51% of demands, epilepsy, with 6%, and the disorder attention deficit hyperactivity disorder (ADHD), with 3%.

In the case of the public sector, the pattern is more heterogeneous. Demands requesting treatments for these disorders (ASD and ADHD) and diabetes, for example, represent, in each case, 10% of the actions.

According to Vanessa Boarati, coordinator of the study and the public health research center at Insper, the group already imagined that there would be differences in relation to race and income profile in actions against public health and private health.

However, I did not expect such a big difference in relation to the proportion of diseases claimed, gender and the path to access to justice in both spheres.

“Autism in supplementary health is very significant. In public health, the demands are more inclusive, involving people with lower income and more diverse social groups.”

She states that it is still not possible to know, for example, why autism appears in a much higher proportion in actions against health plans.

“Is it underreported in the SUS? There are people who speculate that, when diagnosed with autism, a person contracts a health plan [para demandar o tratamento que deseja via judicial]but I think it’s a very speculative hypothesis.”

For the researcher, inequality of access to autism services and social stigma may also be associated with the lower proportion of black and brown children diagnosed in general, which may also reflect on the judicialization of treatments.

According to the study, the action of courts in these cases would mirror and replicate structural inequalities in access to diagnosis and treatment and does not necessarily expand health policy, public or private.

“Children who have more access to healthcare via supplemental healthcare win more expensive claims for more complex treatments,” the researchers write.

According to Boarati, the next stage of the work will delve deeper into these demands of autism. “We are doing a mapping to find out what is being demanded. What treatments are requested? Are they granted or rejected? What are the values ​​of these causes?”

For the researcher, it is important to demystify the issue of judicialization, which tends to be seen in society in general as a single bloc, with groups with greater socioeconomic power using the courts to gain greater access to services and treatments.

“The judicialization of health is yet another instance in which these inequalities are replicated. Social conditions are not just causes of health conditions, but causes of the causes of health conditions, reducing opportunities for access to health information.”