Artigo Original
MEDICINE AND JUSTICE: STATISTICAL ANALYSIS OF THE JUDICIALIZATION OF MEDICINE AND HEALTH IN BRAZIL IN 2024
Como citar: Pinheiro RDA. Medicina e justiça: análise estatística da judicialização da medicina e da saúde no Brasil em 2024. Persp Med Legal Pericia Med. Vol. 10, 2025; 250839.
https://dx.doi.org/10.47005/250839
Recebido em 21/11/2024
Aceito em 17/12/2025
The authors report no conflict of interest.
MEDICINE AND JUSTICE: STATISTICAL ANALYSIS OF THE JUDICIALIZATION OF MEDICINE AND HEALTH IN BRAZIL IN 2024
Resumo
A temática enfocada no presente estudo refere-se à análise das métricas e dados acerca da judicialização da saúde e da medicina no Brasil, especificamente em como essas ações judiciais influenciam o desenvolvimento de negócios no setor da saúde. Esta influência ocorre ao afetar os riscos associados à atividade médica empresarial, impactando empresas que operam tanto no Sistema Público de Saúde (SUS) quanto no setor privado. À luz do exposto, o objetivo geral desta pesquisa foi analisar as estatísticas recentes sobre a judicialização da saúde no Brasil para identificar os principais riscos judiciais para médicos e empresários do setor, visando aprimorar o planejamento estratégico e reduzir a insegurança jurídica. No tocante ao procedimento metodológico adotado, foi realizado um levantamento bibliográfico e documental. A pesquisa tomou por base dados e estudos realizados nos últimos dez anos, abrangendo todo o território nacional e envolvendo a justiça federal, as justiças estaduais e os tribunais superiores. Por fim, constata-se que analisar as estatísticas recentes sobre a judicialização da saúde no Brasil, para identificar os principais riscos judiciais para médicos e empresários do setor, pode aprimorar o planejamento estratégico e reduzir a insegurança jurídica. Acredita-se ainda que avaliar todos os resultados, indicando as tendências e direcionamentos para que os médicos e empreendedores do setor da saúde possam mensurar adequadamente seus riscos, pode auxiliar no planejamento dos negócios com mais previsibilidade e segurança.
Palavras Chave: Atividade médica empresarial; Judicialização da saúde; Insegurança jurídica.
Abstract
The theme focused on in this study refers to the analysis of metrics and data regarding the judicialization of health and medicine in Brazil, specifically how these legal actions influence the development of business in the health sector. This influence occurs by affecting the risks associated with business medical activity, impacting companies that operate both in the Public Health System (SUS) and in the private sector. In light of the above, the general objective of this research was to analyze recent statistics on the judicialization of healthcare in Brazil to identify the main legal risks for doctors and businesspeople in the sector, aiming to improve strategic planning and reduce legal uncertainty. Regarding the methodological procedure adopted, a bibliographic and documentary survey was carried out. The research was based on data and studies carried out over the last ten years, covering the entire national territory and involving federal justice, state justice and higher courts. Finally, it appears that analyzing recent statistics on the judicialization of health in Brazil, to identify the main legal risks for doctors and businesspeople in the sector, can improve strategic planning and reduce legal uncertainty. It is also believed that evaluating all results, indicating trends and directions so that doctors and entrepreneurs in the health sector can adequately measure their risks, can help in business planning with more predictability and security.
Keywords (MeSH): Business medical activity; Judicialization of health; Juridical insecurity.
MEDICINE AND JUSTICE: STATISTICAL ANALYSIS OF THE JUDICIALIZATION OF MEDICINE AND HEALTH IN BRAZIL IN 2024
ABSTRACT
The theme focused on in this study refers to the analysis of metrics and data regarding the judicialization of health and medicine in Brazil, specifically how these legal actions influence the development of business in the health sector. This influence occurs by affecting the risks associated with business medical activity, impacting companies that operate both in the Public Health System (SUS) and in the private sector. In light of the above, the general objective of this research was to analyze recent statistics on the judicialization of healthcare in Brazil to identify the main legal risks for doctors and businesspeople in the sector, aiming to improve strategic planning and reduce legal uncertainty. Regarding the methodological procedure adopted, a bibliographic and documentary survey was carried out. The research was based on data and studies carried out over the last ten years, covering the entire national territory and involving federal justice, state justice and higher courts. Finally, it appears that analyzing recent statistics on the judicialization of health in Brazil, to identify the main legal risks for doctors and businesspeople in the sector, can improve strategic planning and reduce legal uncertainty. It is also believed that evaluating all results, indicating trends and directions so that doctors and entrepreneurs in the health sector can adequately measure their risks, can help in business planning with more predictability and security.
Keywords: Business medical activity; Judicialization of health; Juridical insecurity.
The focus of this research is the analysis of metrics and data regarding the judicialization of health and medicine in Brazil, enabling the measurement of potential impacts caused by these legal actions on business development in the health sector. The impacts caused by the legal risks of business medical activity affect both companies operating through the Public Health System (SUS) and those solely operating in the private sector.
The judicialization of health is characterized by legal demands in which citizens resort to the Judiciary to ensure their right to health when not spontaneously provided by the state under the law. On the other hand, the judicialization of medicine refers to compensation lawsuits filed by patients due to damages allegedly suffered from medical activity, mainly covering private health services provided through liberal professionals, supplemental health plans, clinics, and hospitals.
Regarding the methodological procedure adopted, a bibliographic and documentary survey was carried out. This is a quantitative-qualitative study of descriptive-exploratory nature concerning the outlined objectives. The research was based on data and studies carried out over the last ten years, covering the entire national territory and involving federal justice, state justices, and higher courts to answer the questions provided in the following topic.
Brazil is the only country in the world with more than 100 million inhabitants that opted to offer a universal public health system through the Unified Health System – SUS. However, many of the health rights provided for in the 1988 Federal Constitution are not actually provided to citizens, who often need to resort to justice. Thus, the Judicialization of Health is part of the lives of millions of Brazilians due to the inefficiency of our chaotic and failed public health system.
The Judicialization of Medicine is another phenomenon in constant growth, especially amidst so many changes. The accelerated development of the private health market is a significant factor in this aspect. By the end of 2023, there were already 389 medical courses in the country, with 429% created in the last 10 years alone. However, this growth was not accompanied by quality; according to the Federal Council of Medicine (CFM), more than 90% of the new educational institutions are in municipalities with a deficit in the minimum teaching infrastructure.
We started the year 2024 with more than 564 thousand doctors in the country, reaching an average of 27 for every thousand inhabitants. With the poor conditions in the public health network, there was an explosion of entrepreneurship by doctors in the main urban centers, causing a severe inequality in the distribution of doctors across the national territory. About 50% of all doctors are registered in just three states (MG, SP, and RJ), where the best job opportunities are. The high competition in these regions, especially in some medical specialties, worsened the already worrying picture of the commercialization of medicine.
We are experiencing a moment of high entrepreneurship in the health sector, especially in the main urban centers. However, we are also living in a time of increasing legal risk, making it essential for companies operating in the health sector to adequately assess the business environment and all its variables to define where and how to undertake with predictability and security, minimizing risks. However, the lack of data makes the entrepreneur’s work even more difficult, adding another layer of difficulty to the arduous journey of entrepreneurship in the chaotic and lucrative health sector in Brazil.
Without the analysis of qualified data on judicialization, any strategic planning can be considered fragile, exposing the entrepreneur to unforeseen impacts. Legal risk, especially in Brazil, where legal insecurity reigns, must be carefully analyzed before starting any venture, becoming part of the initial analyses to adequately compose strategic planning.
These judicial aspects directly affect the risks associated with business medical activity, impacting companies operating through the Unified Health System (SUS) but especially those venturing into the complex and risky private sector.
However, without adequately mapping the problem, it is impossible to construct an appropriate solution. Therefore, we will address the most relevant aspects of this environment to fill this informational gap.
Although our Federal Constitution guarantees comprehensive access to health in its art. 196, our country has faced a severe problem for decades in providing health to the population, with judicialization being a clear reflection of the inefficiency of the services provided. Let’s see:
Art. 196. Health is everyone’s right and the State’s duty, guaranteed through social and economic policies aimed at reducing the risk of disease and other injuries and at universal and equal access to actions and services for its promotion, protection, and recovery.
Even in cases where services are provided, their precariousness further aggravates the chaotic situation. According to data from the Brazilian Institute for Patient Safety – IBSP, every year, at least 10% of patients are victims of adverse events in health, and 220 thousand end up losing their lives. And the most serious: at least 67% of these adverse events are considered preventable.
One of the most common justifications for the problem is the deficiency of medical personnel, although there are more than 564 thousand professionals active in the country. There are almost 400 medical courses in operation, generating 42 thousand new vacancies per year. Thus, in 10 years, we will be the country with the highest number of doctors worldwide.
However, we suffer from the absence of public policies for equity in the distribution of doctors in the country, as approximately 50% of registered doctors are in three of the 27 federal units (MG, SP, and RJ), with a significant migration to major urban centers where there is no shortage of doctors but good professional opportunities.
But regardless of the location, one thing does not change: the lack of structure and public investment in health services. As a result, many Brazilians can only access health through the judiciary, causing a frightening growth in the number of actions for access to health. According to data released by the National Council of Justice – CNJ, between 2021 and 2022, the volume of health-related lawsuits in Brazil grew by 19%. Let’s see:
Graph 01: Increase in health-related lawsuits in 1 year.
Source: National Board of Justice (CNJ).
This increase does not reflect a general behavior of judicialization in every sector of the economy but a specific data of the health sector, as evidenced by the study published by INSPER, according to which, in a 9-year interval, there was a 198% increase in the volume of health-related lawsuits in the first instance, while the overall volume of lawsuits decreased by 6%. In the second instance, it is no different, with an 85% increase in health cases compared to a 32% decrease in the overall volume of appeals:
Graph 02: Increase in health-related lawsuits in 9 years.
Source: Education and Research Institute (IEP) / National Board of Justice (CNJ).
Thus, we can see that the volume of health-related actions moves in the opposite direction to the overall volume of lawsuits both in the first and second instances.
The direct consequence of this growth in the filing of new demands compared to a lower flow in closing cases is the accumulation of health-related lawsuits in our courts. According to the CNJ the average duration of health-related lawsuits is 439 days until the judgment and 747 days until the case is closed:
Graph 03: Average duration of health-related lawsuits.
Source: National Board of Justice (CNJ).
This delay in the processing and judgment of cases can be explained by a series of factors, but mainly by the complexity of the cases. Most require medical expertise, and the lack of structure and professionals leads to delays in judgments.
According to data from the CNJ and CFM, there are already more health-related lawsuits in Brazil (573.750) than active doctors (562.206), , representing an incredible average of 1.02 lawsuits per doctor. Comparing these numbers to the population of Brazil, we have the frightening indicator of 2.59 lawsuits per thousand inhabitants:
Graph 04: Quantity and average of health-related lawsuits in Brazil.
Source: National Board of Justice (CNJ) / Federal Board of Medicine (CFM).
A detailed analysis of the data provided by the CNJ allows us to verify that most of these lawsuits are in State Justice (86.52%) and only 13.48% in Federal Justice. Let’s see:
Graph 05: Sphere of proceedings for lawsuits.
Source: National Board of Justice (CNJ) / Federal Board of Medicine (CFM).
The data explored so far allow us to understand the growth of judicialization at the national level. However, our country has continental proportions, and the different geographical regions certainly bring completely different risks that must be accurately measured by health sector entrepreneurs to define the best geographical location for their business, among other details.
Next, we will analyze the data on judicialization in a regionalized manner to specifically determine the judicialization situation in each region.
The impact of judicialization of health certainly varies in different regions of the country due to a series of variables. Therefore, it is necessary to analyze the regionalized impacts of judicialization to achieve accurate metrics, enabling better planning.
In this aspect, analyzing CNJ data on the distribution of lawsuits among the five macro-regions of our country, we identify that the region with the highest volume of lawsuits per inhabitants is the South region, with 5.11 lawsuits for every 1,000 inhabitants. The Southeast region is second with 3.12, followed by the Center-West region with 2.72 lawsuits. The Northeast region appears fourth with 1.85, and finally, the North region with 0.80 lawsuits for every 1,000 inhabitants:
Graph 06: Ranking of regions with the most lawsuits per inhabitants.
Source: National Board of Justice (CNJ).
It is noted that the litigation to enforce the right of access to health increases from south to north of the country when analyzed concerning the population volume. Undoubtedly, this is valuable data for any strategic planning in the health sector.
However, considering that a large part of health sector entrepreneurs are doctors, we can compare the total lawsuits and the population of doctors in each region to achieve an even more interesting indicator. Thus, we determined the number of doctors registered in each region of the country through data provided by CFM, and compared this data with the volume of lawsuits in each region through data provided by CNJ. As a result, we found a ratio between the regions quite different from that presented in the previous graph.
Using this diverse methodology, the South region remains first with 1.75 lawsuits per registered doctor. However, the Center-West region appears second with 1.10. In third place is the Northeast region with 1.02, the Southeast region fourth with 0.81, and finally, the North region with 0.58, as shown below:
Graph 07: Ranking of regions with the most lawsuits per doctors.
Source: National Board of Justice (CNJ) / Federal Board of Medicine (CFM).
According to the data above, we can affirm that the judicial risk is higher for medical activity in regions with a higher index (south) and lower in those listed at the bottom of the graph (north), indicating quite diverse possibilities for entrepreneurs in these regions.
We further deepened the regional analysis, making it even more specific, verifying the federal units with the highest volume of actions with the CNJ. As seen in the graph below, the state of São Paulo is the federal unit with the highest number of active health-related lawsuits, totaling 133,500 actions. The state of Rio Grande do Sul is second with 83,710 lawsuits, followed by Minas Gerais in third with 50,520, Rio de Janeiro with 33,750, and Bahia fifth with 27,730 lawsuits.
Graph 08: Ranking of federal units with the most lawsuits.
Source: National Board of Justice (CNJ).
However, the absolute number of lawsuits is a data that, analyzed in isolation, can be misleading. It is natural that more populous regions (such as São Paulo) present a higher number of lawsuits.
Seeking more useful indicators, we compared the volume of lawsuits in each state, available in the graph above, with their respective population. Using this methodology (demonstrated in the graph below), Rio Grande do Sul moved to first place with 8.47 lawsuits per thousand inhabitants, followed by São Paulo with 3.03, Minas Gerais with 2.88, Bahia fourth with 2.25, and Rio de Janeiro fifth with 1.97. Let’s se:
Graph 08.1: Ranking with the average lawsuits per inhabitants.
Source: National Board of Justice (CNJ).
The change in analysis methodology shows surprising results. When analyzed under the aspect of lawsuits per population, Rio Grande do Sul has an index almost three times higher than the state of São Paulo, which appeared first in the previous graph.
Seeking even more useful data, we compared the volume of lawsuits of these federal units with the volume of doctors in each of them, according to CFM data. Although the state of Rio Grande do Sul remains first with 2.36 lawsuits per doctor, the state of Bahia appears second with 0.99. In third place is the state of São Paulo with 0.84, followed by Minas Gerais with 0.74, and finally, Rio de Janeiro with 0.50 lawsuits per doctor. Let’s see:
Graph 08.2: Ranking with the average lawsuits per doctors.
Source: National Board of Justice (CNJ) / Federal Board of Medicine (CFM).
We can note that litigation varies greatly from state to state, and certainly the variation occurs similarly among the thousands of municipalities that make up our vast country. Therefore, good strategic planning must necessarily analyze the degree of litigation to adequately measure one of the main risks inherent in the health sector.
In general, we can consider that the risks related to the judicialization of health are relatively lower in the North of the country and increase as one moves southward, where the rates are drastically higher. These differences possibly occur due to the greater precariousness of the judiciary structure in the northern regions of the country, as well as the lower level of education of that population. However, these are aspects that demand specific and structured research to be analyzed and measured accurately.
2.2 JUDICIALIZATION OF MEDICINE
Although ensuring access to health for the entire population is a public duty, the Federal Constitution grants the private sector the prerogative to operate in the sector:
Art. 199. Health assistance is free to private initiative.
Based on this right, there has been significant development of the private network in recent years, enabling many doctors to escape the decaying public network, seeking better working and remuneration conditions in the private sector, which has become highly competitive.
We cannot disregard the significant changes our society has undergone in recent decades, with a true transformation in service delivery standards. In the wake of these changes, the doctor-patient relationship has distanced itself from Hippocratic standards, entering a deep crisis due to a growing mismatch of expectations between the parties, causing the crises that lead to lawsuits.
Individuals and legal entities providing private health services are civilly liable for the acts committed, having the obligation to compensate in case of unlawful acts under the Civil Code:
Art. 186: He who, by voluntary action or omission, negligence, or recklessness, violates rights and causes damage to others, even if exclusively moral, commits an unlawful act.
(…)
Art. 927: He who causes damage to others through an unlawful act is obliged to repair it.
These demands exactly compose the judicialization of medicine: the effective lawsuits in which patients seek compensation for damages against doctors for alleged errors in care, especially in the private health network.
Next, we will analyze data on the Judicialization of Medicine, presenting it in a way that helps health sector entrepreneurs measure the litigation and risks arising from their profession and specialty in different regions of the country.
We will start by analyzing the most judicially demanded medical specialties. According to a study conducted in 2016 by ANADEM, based on the analysis of all appeals judged by the Superior Court of Justice (STJ) in 10 years, the most judicially demanded medical specialty by patients is Gynecology and Obstetrics, appearing in 42.60% of cases. The second is Traumatology and Orthopedics with 15.91%, followed by Plastic Surgery and General Surgery with 7% each. In fifth place is Internal Medicine with 6% of cases, followed by Neurosurgery with 5.18%. Pediatrics occupies the seventh place with 4.46%, followed by Otorhinolaryngology with 3.03%. Anesthesiology and Ophthalmology close the list of the ten most demanded specialties with 2.85% each:
Graph 09: Most sued medical specialties – STJ.
Source: Brazilian Society of Medical Law and Bioethics – ANADEM.
The correct identification of medical specialties with higher or lower legal risk is essential data for the development of a strategic plan in the health area. Among the more than 50 medical specialties, we can see that only one of them accounts for 42.6% of the entire judicial liability, with almost three times more lawsuits than the second place. On the other hand, there are specialties that do not even appear as demanded, presenting a risk close to zero.
When we focus our analysis only on public health, however, we find significant variation concerning the data presented above. A study conducted by CNJ in 2021 showed that the most demanded specialties in the state public health network are Traumatology and Orthopedics first, Cardiology second, followed by Ophthalmology, and finally Clinical Oncology fourth and Urology fifth:
Graph 10: Most sued specialties in the state public network.
Source: National Board of Justice (CNJ).
The same study indicates that in the municipal public network, Traumatology and Orthopedics appear as the most demanded specialty, followed by Ophthalmology second, Psychiatry third, Cardiology fourth, and Neurology fifth. Let’s see:
Graph 11: Most sued specialties in the municipal public network.
Source: National Board of Justice (CNJ).
However, unlike the other studies mentioned, the methodology used by CNJ in conducting this research is questionable. The identification of the most demanded specialties was carried out through interviews with health unit managers and not through the analysis of concrete cases before the Judiciary. Therefore, the referred data may not accurately reflect reality but only the perception of the individuals interviewed, which may or may not be based on evidence.
Another essential indicator for our analysis of the risks of judicialization of medicine is the verification of the composition of the passive pole in compensation lawsuits. This is a very pertinent data for risk analysis, as in general, the responsibility of legal entities is objective (that is, regardless of fault), while the civil liability of the doctor, as a liberal professional, is subjective (depending on proof of fault for the obligation to compensate).
In this aspect, the study conducted by ANADEM indicated that in only 16% of cases, the doctor appears alone in the passive pole. In 38% of cases, there is a legal entity in the passive pole with the doctors, and in 46% of cases, there is only the legal entity without the doctor. Let’s see:
Graph 12: Defendants in lawsuits against doctors – STJ.
Source: Brazilian Society of Medical Law and Bioethics – ANADEM.
But the mere presence of the legal entity may not be sufficient for accurate analysis, and it is pertinent to analyze the nature of the legal entity in the passive pole of lawsuits. According to the same ANADEM study, in 16.67% of cases, they were supplemental health operators. In 37.50% of cases, it was the public authority, and only in 45.83% were hospitals and clinics:
Graph 13: Legal entities sued in lawsuits against doctors in the STJ.
Source: Brazilian Society of Medical Law and Bioethics – ANADEM.
If the entrepreneur wishes to operate in supplemental health, the risk to be analyzed is present in 16.67% of the total cases, while if the operation is through hospitals and clinics, the risk almost triples, reaching 45.83% of lawsuits.
Finally, there is another highly valuable data provided by the ANADEM study, which presents the gender of the patients who are plaintiffs, allowing a risk analysis considering the entrepreneur’s target audience. According to the research, 59.35% of the patients are female, and the remaining 40.65% are male:
Graph 14: Gender of plaintiffs in lawsuits against doctors – STJ.
Source: Brazilian Society of Medical Law and Bioethics – ANADEM.
These data suggest that specialties like gynecology would be exposed to higher risks than specialties like andrology, simply due to gender.
Another interesting data present in the graph above concerns the gender of the sued doctor. According to the ANADEM research, 88% of defendants are male and only 12% are female, indicating a significantly higher risk for men compared to women. Therefore, regarding the practice as a liberal professional and not through a legal entity, it is possible to identify a significant imbalance in risk based on gender.
For better decision-making regarding regionality, we once again resort to the excellent study conducted by ANADEM. Although the research was conducted over 8 years ago, it is the only survey carried out in this regard with a highly reliable methodology, collecting all cases addressing the topic in all state courts in the 10 years preceding the research, generating highly reliable results.
We will begin by analyzing the conviction rates of doctors in lawsuits in the five federal units with the highest volume of cases. According to ANADEM data, the federal unit with the highest risk is Bahia with exactly 50% of convictions. In second place is Rio de Janeiro with 43.05%, followed by Rio Grande do Sul with 36.26%. São Paulo appears fourth with 30.42%, and finally Minas Gerais with only 30.21% of convicted doctors:
Graph 15: Conviction rates of doctors in the states with the most lawsuits.
Source: Brazilian Society of Medical Law and Bioethics – ANADEM.
This analysis shows that the risk of conviction in some regions reaches 50%, while in others it is close to 30%, representing significant variation.
Even more important is the analysis of the most demanded specialties in each of these states. While some federal units present data consistent with the national metric, others show significant differences, indicating completely different risks. In São Paulo, the state with the highest absolute number of lawsuits in the country, Gynecology and Obstetrics is the most demanded specialty with 23.66% of cases. Traumatology and Orthopedics is second with 16.47%, followed by Internal Medicine with 9.96%, and Plastic Surgery with 6.08%. Pediatrics appears fifth with 5.91%:
Graph 16: Most sued medical specialties in São Paulo.
Source: Brazilian Society of Medical Law and Bioethics – ANADEM.
In Rio Grande do Sul, Gynecology and Obstetrics also appears first with 21.42%. Traumatology and Orthopedics is second with 17.20%, followed by Plastic Surgery with 10.82%, and Internal Medicine with 10.17%. Ophthalmology appears fifth with 4.98%, as shown below:
Graph 17: Most sued medical specialties in Rio Grande do Sul.
Source: Brazilian Society of Medical Law and Bioethics – ANADEM.
In Minas Gerais, Gynecology and Obstetrics remains ahead with 27.49%. Internal Medicine is second with 18.92%, followed by Traumatology and Orthopedics with 11.38%, and General Surgery with 8.69%. Plastic Surgery appears fifth with 8.43%. Let’s see:
Graph 18: Most sued medical specialties in Minas Gerais.
Source: Brazilian Society of Medical Law and Bioethics – ANADEM.
Also in Rio de Janeiro, Gynecology and Obstetrics is first with 23.66%. Traumatology and Orthopedics is second with 17.02%, followed by Internal Medicine with 11.41%, and Ophthalmology with 6.25%. General Surgery appears fifth with 4.77%, as shown below:
Graph 19: Most sued medical specialties in Rio de Janeiro.
Source: Brazilian Society of Medical Law and Bioethics – ANADEM.
In Bahia, Gynecology and Obstetrics also ranks first with 23.52%. Internal Medicine is second with 11.76%, followed by Plastic Surgery and Gastroenterology with 8.69% each. General Surgery appears fifth with 5.88%:
Graph 20: Most sued medical specialties in Bahia.
Source: Brazilian Society of Medical Law and Bioethics – ANADEM.
While some specialties show little or no variation between the analyzed regions, such as Gynecology and Obstetrics, which leads in all rankings, others show interesting variation, such as Pediatrics, which only appears in São Paulo’s ranking.
2.3 ETHICAL-PROFESSIONAL PROCESSES
Although the primary focus of our study is lawsuits, the risk for doctors who undertake in the health sector is not limited to the judicial sphere, as there are also ethical-professional risks that can even permanently end a doctor’s career through the penalty of professional license revocation. Therefore, it is crucial to also evaluate ethical risks and compare them with judicial risks.
According to data released by CFM in 2019, over a 10-year period, there was a 302% increase in the number of ethical processes and a 180% increase in conviction rates:
Graph 21: Ethical processes at CFM in 10 years.
Source: São Paulo Regional Board of Medicine (CRM-SP) | Federal Board of Medicine (CFM).
Analyzing the most recent data released by CFM regarding ethical processes judged in 2023, we found that a total of 712 appeals were filed with CFM against decisions made by regional medical councils in ethical-professional processes, with 659 in the chamber and 53 in the plenary.
We verified the most demanded specialties in the 659 judgments conducted in the CFM chamber in 2023 and found that Internal Medicine is the most demanded specialty with 23.5% of cases. Gynecology and Obstetrics is second with 14.3%, followed by Plastic Surgery with 6.3%, Emergency Medicine fourth with 5.2%, and Dermatology fifth with 5%. Let’s see:
Graph 22: Most demanded specialties in the CFM Chamber.
Source: Federal Board of Medicine (CFM).
Although Gynecology and Obstetrics is an absolute consensus in judicial indices, in ethical-disciplinary process judgments at CFM, it is surpassed by Internal Medicine with almost double the cases.
The same study released by CFM regarding judgments conducted in 2023 indicates that out of the 53 penalties confirmed by the CFM plenary, 14 doctors had their licenses permanently revoked, representing 25.9% of cases. Thirteen doctors received the penalty of activity suspension, indicating 22.4%:
Graph 23: Penalties applied by the CFM Plenary.
Source: Federal Board of Medicine (CFM).
It is found that the rates of more severe convictions in ethical processes reach a total of 48.3% of cases, showing higher than the average conviction rate in the five states with the most lawsuits, which is 38.27%. Therefore, ethical risk cannot be ignored in the strategic planning of health sector entrepreneurs.
This study highlighted the complexity and increasing judicialization of health and medicine in Brazil, emphasizing how these dynamics directly affect business development in the health sector. It was observed that the lack of targeted research exacerbates companies’ difficulty in measuring and managing legal risks, compromising strategic planning and amplifying the negative effects of legal uncertainty on organizational financial performance.
The analysis of recent statistics on judicialization showed that not only is the volume of lawsuits a concern, but also the variety and specificity of cases in different regions of the country. This regionalization of data revealed that understanding the phenomenon requires a multifaceted approach, considering geographic, demographic, and specialized factors within the medical field.
It is essential to emphasize that legal uncertainty, catalyzed by the lack of reliable data and a superficial understanding of the risks involved, can lead to business instability. Therefore, health sector professionals, both in the public and private spheres, must be equipped with accurate and contextualized information to make more informed strategic decisions.
Moreover, the results of this work underline the need for closer collaboration between the legal sector and health professionals to develop strategies that minimize judicialization risks. It is essential to create policies and practices that not only respond to legal requirements but also promote effective risk management and proactive planning.
In conclusion, this study not only illustrates the challenges faced by professionals and entrepreneurs in the health sector due to judicialization but also highlights the importance of a strategic and informed approach to dealing with these risks. It is hoped that the trends and directions identified here will serve as a basis for future investigations and the improvement of practices in the sector, contributing to the sustainability and effectiveness of health services in Brazil.
REFERENCES
BRASIL. [Constitution (1988)]. Constitution of the Federative Republic of Brazil of 1988. Brasília, DF: President of the Republic, 1988.
BRASIL. Law n. 10,406 of January 10, 2002. Civil Code.
CANAL, Raul. Brazilian Jurisprudential Thought in the Third Millennium on Medical Error, São Paulo: Eceat, 2016.
CFM, Federal Council of Medicine. Transparency and Accountability Portal, CFM, 2023. Available at: https://transparencia.cfm.org.br. Accessed on: Dec 26, 2023.
CNJ, National Council of Justice. Procedural Statistics on the Right to Health. Brasília, CNJ, 2022. Available at: https://paineisanalytics.cnj.jus.br/. Accessed on: Dec 21, 2023.
CNJ, National Council of Justice. Judicialization of Health in Brazil: Profile of demands, causes, and proposed solutions. Research Institute – INSPER. Brasília, CNJ, 2019.
CNJ, National Council of Justice. United Nations Development Programme. Brasília, CNJ, 2021.
CNJ, National Council of Justice. Justice in Numbers 2023, Brasília, CNJ, 2023.
CNJ, National Council of Justice. Judicialization and Society: Actions for access to quality public health. United Nations Development Programme. Brasília, CNJ, 2021.
CNJ, National Council of Justice. Supplemental Health highlights the impact of judicial processes on sector balance. 2023. Available at: https://www.cnj.jus.br/saude-suplementar-pontua-impacto-de-processos-judiciais-para-equilibrio-do-setor/. Accessed on: Dec 21, 2023.
CFM, Federal Council of Medicine. Medical Demography. Available at: https://demografia.cfm.org.br/dashboard/. Accessed on: Dec 26, 2023.
IBSP – Brazilian Institute for Patient Safety. Ten percent of patients should experience adverse events during hospitalization. Available at: https://ibsp.net.br. Accessed on: Dec 21, 2023.
INSPER, Institute of Education and Research. Judicialization of Health skyrockets and already costs 13 billion to the Union. 2019. Available at: https://www.insper.edu.br/conhecimento/direito/judicializacao-da-saude-dispara-e-ja-custa-r-13-bi-a-uniao. Accessed on: Dec 21, 2023.
PORTAL EBSERH, Lecture addresses the new medical code of ethics. Available at: https://www.gov.br/ebserh/pt-br/hospitais-universitarios/regiao-nordeste/hu-ufma/comunicacao/noticias/palestra-aborda-o-novo-codigo-de-etica-medica. Accessed on: Dec 21, 2023.
SCHEFFER, M. et al. Medical Demography in Brazil 2023. São Paulo, SP: FMUSP, AMB, 2023.
VIEIRA, Fabiola Sulpino. Right to Health in Brazil: its contours, judicialization, and the need for macrojustice. Institute of Applied Economic Research – IPEA. Rio de Janeiro, 2020.
References
BRASIL. [Constituição (1988)]. Constituição da República Federativa do Brasil de 1988. Brasília, DF: Presidente da República, 1988.
BRASIL. Lei n. 10.406, 10 de janeiro de 2002. Código Civil.
CANAL, Raul. O Pensamento Jurisprudencial Brasileiro no Terceiro Milênio sobre Erro Médico, São Paulo: Eceat, 2016.
CFM, Conselho Federal de Medicina. Portal da Transparência e Prestação de Contas, CFM, 2023. Disponível em: https://transparencia.cfm.org.br. Acesso em: 21 dez. 2023.
CNJ, Conselho Nacional de Justiça. Estatísticas Processuais de Direito à Saúde. Brasília, CNJ, 2022. Disponível em: https://paineisanalytics.cnj.jus.br/. Acesso em: 21 dez. 2023.
CNJ, Conselho Nacional de Justiça. Judicialização da Saúde no Brasil: Perfil das demandas, causas e propostas de soluções. Instituto de Pesquisa – INSPER. Brasília, CNJ, 2019.
CNJ, Conselho Nacional de Justiça. Programa das Nações Unidas para o Desenvolvimento. Brasília, CNJ, 2021.
CNJ, Conselho Nacional de Justiça. Justiça em Números 2023, Brasília, CNJ, 2023.
CNJ, Conselho Nacional de Justiça. Judicialização e Sociedade: Ações para acesso à saúde pública de qualidade. Programa das Nações Unidas para o Desenvolvimento. Brasília, CNJ, 2021.
CNJ, Conselho Nacional de Justiça. Saúde Suplementar pontua impacto de processos judiciais para equilíbrio do setor. 2023. Disponível em: https://www.cnj.jus.br/saude-suplementar-pontua-impacto-de-processos-judiciais-para-equilibrio-do-setor/. Acesso em: 21 dez. 2023.
CFM, Conselho Federal de Medicina. Demografia Médica. Disponível em: https://demografia.cfm.org.br/dashboard/. Consulta em Acesso em: 26 dez. 2023.
IBSP – Instituto Brasileiro para Segurança do Paciente. Dez por cento dos pacientes deve sofrer evento adverso em internação. Disponível em: https://ibsp.net.br. Acesso em: 21 dez. 2023.
INSPER, Instituto de Ensino e Pesquisa. Judicialização da Saúde dispara e já custa 13 bi à União. 2019. Disponível em: https://www.insper.edu.br/conhecimento/direito/judicializacao-da-saude-dispara-e-ja-custa-r-13-bi-a-uniao. Acesso em: 21 dez. 2023.
PORTAL EBSERH, Palestra aborda o novo código de ética médica. Disponível em: https://www.gov.br/ebserh/pt-br/hospitaisunregiaonordeste/hu ufma/comunicacao/noticias/palestra-aborda-o-novo-codigo-de-etica-medica. Acesso em: 21 dez. 2023.
SCHEFFER, M. et al. Demografia Médica no Brasil 2023. São Paulo, SP: FMUSP, AMB, 2023.
VIEIRA, Fabiola Sulpino. Direito à Saúde no Brasil: seus contornos, judicialização e a necessidade da macrojustiça. Instituto de Pesquisa Econômica Aplicada – IPEA. Rio de Janeiro, 2020.
