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Impact evaluation of technical notes issued by NATJUS on healthcare judicialization
Lucas Reis Correia1,2, Luís Gustavo Nascimento de Paula1, Julio Trecenti3
1Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Introduction:
Technical Support Centers of the Judiciary (NATJUST), provide health technology assessments to judges in health-related litigations against both public and private healthcare systems. These centers provide technical notes, that can assist Brazilian Courts in making provisional rulings and determining patient access to health services during legal proceedings.
Objective:
This study aimed to evaluate the impact of NATJUS technical notes on preliminary injunctions in lawsuits against the Brazilian Unified Health System. Specifically, we analyzed the alignment between judicial decisions and technical notes recommendations, assessed lawsuit costs, and examined NATJUS-generated savings for Brazilian Unified Health System. Furthermore, we examined the technical notes issued by Hospital Israelita Albert Einstein, which manages the national NATJUS.
Methods:
We constructed a database of lawsuits with and without NATJUS technical notes. Using random forest models, we predicted the potential outcomes of preliminary injunctions where technical notes were available. Savings were estimated by examining the relationship between preliminary injunctions and case values, then compared with potential injunctions incorporating technical notes recommendations.
Results:
The technical notes recommendations and judges' decisions were aligned in 76% of the cases, with median savings from lawsuits amounting to BRL10,120. The estimated impact of NATJUS technical notes for Brazilian Unified Health System indicated median savings of BRL1,312.74 per case per year. Between 2020 and 2022, NATJUS resulted in total savings of BRL111.4 million. Focusing on Hospital Israelita Albert Einstein NATJUS, the cost savings for Brazilian Unified Health System amounted to BRL27 million, which indicates a return on investment of BRL1.66 per BRL1 invested in the project.
Conclusion:
Our findings indicate the economic importance of technical notes in shaping preliminary injunctions, not only elevating decision quality but also fostering evidence-based judicial processes.
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