The Paradox of Health Litigation: The Tension Between the Effectiveness of Individual Rights and the Sustainability of Public Policies.
Judicialization of health. Health Economics. Public Policy. SUS. Public Management.
The judicialization of healthcare has established itself as a complex and global phenomenon, characterized by the tension between individual rights and distributive justice. In Brazil, this trend intensified following the 1988 Constitution, which expanded the role of the Judiciary and strengthened the capacity to judicially claim social rights. This movement has resulted in an increasing transfer of decision-making from administrative and legislative spheres to the Judiciary, which has begun to act as a regulator of healthcare access in the face of state failures and assistance gaps. Although it has contributed to the enforcement of rights, judicialization also generates negative impacts on the planning, financing, and sustainability of the Unified Health System (SUS). Individualized and unpredictable judicial rulings can compromise the rational allocation of resources, deepen inequalities, and further strain a historically underfunded system, particularly as the Judiciary lacks a budgetary management function and does not adhere to the technical-sanitary criteria of public policies. Conversely, this phenomenon can stimulate institutional innovation by exposing weaknesses in policy implementation and inducing improvements in governance and administrative transparency. Thus, judicialization presents itself simultaneously as a symptom of structural problems and an opportunity for the improvement of the SUS. Given its complexity, an interdisciplinary approach—articulating Law, Public Management, and Health Economics—is essential to understand not only the fulfillment of rights but also the effects of judicialization on equity, financial sustainability, and the governance of the healthcare system. Health Economics, specifically, provides analytical tools to evaluate the costs, benefits, and distributive impacts of judicial decisions, favoring a more efficient use of public resources.