Right to Health and Public Policies: Legal and Economic Context, Effectiveness and Content in Times of Crisis
access to health; public policy; unified health system, effectiveness.
The 1988 Federal Constitution explicitly included, for the first time in the history of Brazilian constitutionalism, the right to health as a fundamental right. Since then, there has been an intense debate in society, in legal doctrine and in the courts about the right to health. The idea that the constitutional right to health represents a universal right has been consolidated, although it has not been possible to establish parameters to delimit it. Thus, this thesis investigates health as a constituted right, the formulation and implementation of health as a public policy and also the impact of the judicialization of health in Brazil, with an emphasis on the implications for the effectiveness of public policies and for the financing of the Unified Health System (SUS). The research starts from the observation that, although judicialization is a legitimate mechanism for the defense of individual rights, it has generated significant distortions in the allocation of public resources, potentially aggravating inequalities in access to health, among other phenomena also mentioned in the text. To this end, the text comprises three sections: the first provides a historical context for the right to health and the creation of the SUS, exploring the legal and institutional challenges faced by the system. The second section examines public policies. Finally, the third section focuses on the economic and social dimensions that restrict the system's ability to meet the population's growing demands and the phenomenon of judicialization. It is possible to note that the commodification of the health system plays a preponderant role, due to the growing increase in supplementary health in the country, with direct consequences for the underfunding of the health system, with emphasis on the budgetary impacts and tensions between judicial decisions and public policies and, finally, the impact on the budget allocated to health. The conclusion suggests that, in order to ensure the sustainability of the SUS, it is necessary to balance the protection of individual rights with the responsible management of public resources, promoting a more effective alignment between the Judiciary, the Executive and health policies.
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