4 out of 10 lawsuits for the judicialization of children’s health in SP involve treatment of autistic people

Four out of ten actions that are decided by the Justice of the State of São Paulo for the health care of children and adolescents are related to the treatment of patients with autism spectrum disorder (ASD).

When the processes are separated by sector, the condition was responsible for 49% of the requests in the private network that obtained a decision from 2011 to 2022. In the public sector (without distinction of municipal, state or federal), in turn, the main cases were related to the treatment of diabetes (10%) and attention deficit hyperactivity disorder (ADHD, with 7%).

The data are from an unprecedented research developed by Insper’s Center for Law, Health and Public Policies. The complete study will be published in December, but the preliminary results were released last Saturday (8) at a meeting promoted by the José Luiz Egydio Setúbal Foundation and the Sabará Children’s Hospital.

In general, according to the survey, the São Paulo Court of Justice gave a favorable opinion to about 61% of the requests for action for the care of children and adolescents in the period, considering the decisions in an injunction (provisional).

A favorable response appears in 82% of cases sent to the public sector and in about 53% in the private sector.

The main reasons for resorting to justice for the treatment of these patients are the need for service or medication coverage, indemnification or reimbursement of coverage — the latter in the case of the private sector.

According to Vanessa Boarati, the study’s main researcher, the survey was motivated by the lack of information on the processes of judicialization of child health in the scientific literature.

“We didn’t find any previous study with the characteristics of requests made to the Justice to treat children and adolescents. What we saw is that requests are generally resolved in the first instance, they almost never go to the second, and that the judges in most cases defer in favor of the patient”, he explains.

To carry out the survey, the researchers accessed the judgment bank of the Court of Justice of São Paulo (first instance).

From a total of 37,619 cases, 993 were selected that concerned requests for patients aged zero to 18 years. A second analysis selected only those who had a published decision, which represented 55.6% of the sample, or 550. The study period was from 2011 to 2022, with partial data this year.

Requests made for the provision of services by private health represented more than two thirds (almost 70%) of the total requests, while those directed to the public sector were about one third (29.95%).

The majority of requests also referred to the service of boys (63%), while girls represented 3 in 10 of the requests made (33.7%). Gender was not determined in 3% of requests.

In 80% of the requests it was not possible to know the age of the patients. In cases where this was possible, children aged 0 to 3 years accounted for 65% of the cases.

According to Boarati, it is at this age that tests are carried out to diagnose, for example, ASD, whose incidence is higher in boys, ADHD (attention deficit hyperactivity disorder, which represents the second main cause for requests in the public sector ) and diabetes mellitus — or type 1 diabetes, when the patient needs insulin injections.

The researcher also says that the result that more requests are made for supplementary health care is not surprising, but she points out that the proportion of requests granted is higher in the public sector.

“That’s because applicants often ask health plans, in addition to service coverage, for compensation or reimbursement. In the case of compensation, it represents about 20% of lawsuits, but most judges consider it rejected. public sector, compensation is almost non-existent”, he explains.

Also according to the researcher, the reason for the TEA to lead the requests for legal action for the granting of treatment is the modality of therapy known as ABA (Applied Behavior Analysis), whose method, benefits and proof are still pending. under discussion in the scientific community.

Although the incidence of childhood diabetes is lower than in the adult population, this diagnosis also occurs early in childhood. “This may justify why the main type of condition that leads to lawsuits in the public sector is diabetes. [Sistema Único de Saúde] treatments with human insulin, other types of treatment and supplies are offered in the private sector, but not in the public sector”, he says.

The next stage of the study will investigate the costs of the judicialization of children’s health in the state of São Paulo, which may involve both the purchase of medicines that are not included in the treatments incorporated by the SUS and those outside the ANS (National Health Agency) list. Supplementary Health).

This year, the list underwent an important change, from being exhaustive to being exemplary (when it serves only as a reference for health plans).

In a note, the State Department of Health of São Paulo said that it has been expanding strategies to improve management and reduce public spending with judicializations that privilege individual rights, contrary to the universal assistance advocated by the SUS.

The ministry claims to work “to meet all legal demands in the shortest possible time”, but the bidding processes can take time because “each phase has a determined deadline to be completed”.

“Many cases arrive with preliminary decisions for the immediate delivery of medicines, and many of the medical requests indicate treatments that are not available in the Unified Health System (SUS) network, including imported medicines, which are not produced in Brazil”, says the note. .