Poder judiciário e política pública de saúde: judicialização das demandas de saúde por Covid-19 no Brasil

Abstract

Introduction: The COVID-19 pandemic exposed longstanding structural weaknesses in Brazil's Unified Health System (SUS) and intensified regional inequalities in access to essential services. In the face of insufficient public policies and overwhelmed hospital infrastructure, thousands of Brazilians turned to the judiciary to obtain treatments, ICU beds, and medications. In this context, the judicialization of health emerged as a significant phenomenon, reflecting not only a public health crisis but also disparities in access to justice and in the realization of the right to health. Objective: This thesis aimed to investigate the social and economic impacts of the COVID-19 pandemic on the judicialization of health across Brazilian states. Specifically, it sought to identify the socioeconomic profile of the population that filed lawsuits, examine the relationship between hospital infrastructure and the volume of legal actions, and assess the spatial and budgetary patterns associated with this phenomenon. Methodology: A multidisciplinary approach was adopted, using descriptive statistics, Pearson correlation analysis, and spatial analysis (Moran’s Index), integrating data from official sources such as IBGE, IPEA, FIRJAN, the Ministry of Health, and court rulings collected via the CNJ API. Indicators such as HDI, SVI, and the Gini Index were cross-referenced with data on judicialization, hospital infrastructure, and public health expenditures across Brazil’s 27 states, covering the period from 2019 to 2022. Results: Findings indicate that health-related legal actions were more prevalent in the South and Southeast regions, where higher HDI, educational attainment, and institutional capacity are observed. Conversely, more socially vulnerable regions like the North and Northeast—despite being heavily impacted by the pandemic—registered fewer lawsuits. Judicialization was strongly correlated with human development levels, but not with social vulnerability or income inequality. Relevant correlations were also found between COVID-19 mortality and incidence rates, revealing the pressure exerted on the healthcare system. Conclusion: The study confirms that the judicialization of health during the pandemic is associated with socioeconomic development, revealing a paradox: those who most need justice are often those with the least access to it. While judicialization functions as a mechanism for ensuring rights, it also exposes structural failures in the state's ability to deliver equitable public healthcare. Strengthening SUS, expanding equitable access to justice, and improving public policies are essential steps toward reducing judicialization and promoting social justice in emergency contexts.