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Democracia neoliberal y democracia constitucional: un problema educativo.
Politai 1 2 [Peru]. Elecciones 8 9 : [Peru]. Sistema January : [Spain]. Azpuru, Dinorah, Steven E. Political Crises in Brazil and Argentina]. Constitutional Crises in the s]. Distinguished Research Affiliate, Visiting professor, summer Visiting researcher, spring Universidad Torcuato Di Tella, Argentina. Visiting professor, Visiting faculty, spring Visiting fellow, fall Universidad de Costa Rica.
Workshop on Qualitative Comparative Analysis, May, Guest lecturer, Instructor, Visiting lecturer, summer University of Salamanca, Spain. This approach contrasts with, e. However, the Colombian Court is not alone in enforcing programmatic claims for health services that have significant economic impacts. In Costa Rica, the first ten years of operation of the Sala IV, as the Constitutional chamber of the Supreme Court is known, witnessed an increase in the amparo similar to the Colombian tutela caseload from less than 1, cases to over 11, in , a substantial and growing fraction of which relate to health claims [ 6 ].
In Brazil, thousands of court cases have been brought since relating to access to medications—many of which are highly costly and not included in Brazil's national health plan—resulting in distortions of the health budget [ 3 , 5 ]. Although it is too soon to say, the structural approach adopted by the Court suggests that it might avoid at least some of the pitfalls associated with some of its prior decisions, as well as with the judicialization of health policy-making in general [ 27 , 28 ]. Rather, in keeping with recent proposals in health ethics, the decision calls for a participatory process that is transparent, based on relevant reasons and current epidemiological information, subject to revision, and enforceable [ 29—31 ].
However, in the Court's composition will change substantially, and it is unclear whether the new Court will assume the same degree of responsibility for overseeing the implementation of the judgment's complex structural orders. Further, this decision, like most of the Court's other decisions, is directed at enforcing access to services, treatments, and medications. Yet, paradoxically, the overall trend in judicial activism may in fact reinforce the effects of the health reform, which invested the majority of the health budget in individual insurance at the expense of public health promotion and prevention.
Empirical investigation is needed to determine whether health resources are increased or merely shifted, what the effects on equity are, and whether the overall health system's infrastructure and workforce, as well as health promotion and prevention activities, are neglected as a result of policies stemming from the decision. Yet, the impacts of the Court's activism in relation to the right to health should not be evaluated in isolation from its consideration of other economic and social rights, including housing and education—which are critical social determinants of health—as well as its progressive treatment with respect to gender and ethnic discrimination [ 32—34 ].
Further, grass-roots groups have found in the Court's jurisprudence a political banner that inspires them to use legal strategies to vindicate rights and seek social change [ 34 ]. Nonetheless, Colombia remains a profoundly unequal society, and there are clearly limits to the role of the Court in restructuring the fundamental social disparities that underlie many health inequalities.
To a greater extent than in any other country, the Colombian Constitutional Court has exercised dramatic control over health policies and programming decisions. The Colombian example shows that increased access to courts may under certain circumstances enhance the protection of the right to health, as well as potentially promote equity and transparency in coverage definitions and greater accountability within the health system itself.
However, further investigation is required with regard to the empirical effects of this judgment on the organization of an integrated health system, health budget-setting, and the availability, accessibility, acceptability, and quality of health facilities, goods, and services in Colombia.
Funding: The authors received no specific funding for this article. Competing Interests: The authors have declared that no competing interests exist. Provenance: Not commissioned; externally peer reviewed. National Center for Biotechnology Information , U. PLoS Med. Published online Feb Author information Copyright and License information Disclaimer. E-mail: ude. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
This article has been cited by other articles in PMC. History of Judicial Enforcement of the Right to Health Although coverage has increased since , the Colombian health system has been widely criticized—efficiency and quality gains have generally not materialized, and patients have increasingly turned to the courts to secure treatments and services [ 11—18 ]. Conclusions To a greater extent than in any other country, the Colombian Constitutional Court has exercised dramatic control over health policies and programming decisions.
Click here for additional data file. References Corte Constitucional de Colombia. July 31, Garibello A. El Tiempo. Accessed 15 August Is access to essential medicines as part of the fulfillment of the right to health enforceable through the courts.
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