Mediação sanitária, equidade e eficácia: uma análise do Centro de Mediação de Saúde Pública da Comarca da Ilha de São Luís/MA

Abstract

The dissertation analyzes health mediation as an instrument for the dejudicialization of healthcare, based on the study of the Public Health Mediation Center of the District of São Luís/MA, from 2021 to 2024, within the field of Law and Institutions of the Justice System, and linked to the research line on the Dynamics and Effectiveness of Justice System Institutions. It starts from the problem of the growing judicialization of healthcare, a phenomenon that reveals both the pursuit of the realization of the fundamental right to health and the structural weaknesses of public policies and state management, resulting in an overload of the Judiciary, distributive distortions, and impacts on budget planning. The general objective is to assess the effectiveness of the aforementioned center as a mechanism for dejudicialization, considering its capacity to promote equitable solutions and expand access to justice. The specific objectives include analyzing mediation as an access mechanism, understanding the institutional functioning of the center, and evaluating its results in light of equity. The research adopts the capability approach as its theoretical framework, articulated with access to justice theory, emphasizing the overcoming of structural barriers to the exercise of rights. Methodologically, it employs an inductive approach, applying socio-legal critical and legal-diagnostic methods, as well as a quantitative technique based on the collection and analysis of institutional data related to the operation of the Public Health Mediation Center, particularly indicators of productivity, resolution rates, and the financial volume of agreements reached during the analyzed period. The results show a high resolution rate in the extrajudicial sphere, indicating a strong capacity of the model to prevent judicialization and resolve conflicts before litigation arises, while also demonstrating that mediations conducted within the judicial sphere concentrate a significant volume of financial resources, revealing that the instrument also plays a relevant role in the economic management of already judicialized demands. The data indicate a positive impact on reducing litigation and rationalizing the handling of healthcare demands, although structural limitations remain, particularly regarding integration with public policies and the sustainability of the model. It is concluded that there is room for improvement and refinement of the model; however, despite the identified limitations, the Public Health Mediation Center constitutes an effective instrument for dejudicialization and for expanding access to justice in healthcare matters, contributing to the efficacy of the right to health by combining high extrajudicial resolution rates with the capacity to handle economically sensitive disputes within the judicial sphere.