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Have reforms reconciled health rights litigation and priority setting in Costa Rica?

Voorhoeve, Alex and Luciano, Alessandro (2019) Have reforms reconciled health rights litigation and priority setting in Costa Rica? Health and Human Rights Journal. ISSN 2150-4113 (In Press)

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The Costa Rican experience highlights the potential for conflicts between the right to health and fair priority setting. For example, one study found that a large majority of favorable rulings by the Costa Rican constitutional court concerning claims for medications under the right to health were either for experimental treatments or for medicines that should have low priority on key criteria, including health gain per unit of expenditure and severity of disease.1 In order to better align rulings with priority setting criteria, in 2014, the court began a partnership with the Cochrane Collaboration to assess medicines’ effectiveness. A recent study argues that this reform has reduced the number of successful claims for experimental medications while increasing the overall chance of a lawsuit being successful.2 It concludes that this reform has led to modest gains in fairness. This paper identifies several shortcomings in that study’s analysis. It does not establish the statistical significance of the effects it highlights. Moreover, it overlooks that the reform may have changed the number of cases brought. In addition, it fails to establish the joint impact of these effects. This paper proceeds to remedy these shortcomings. It finds that both (1) the reduction in successful claims for experimental medication and (2) the increase in the success rate of medication lawsuits are statistically significant. Furthermore, it finds (3) a significant decline in the number of claims for medicine. It argues that these three changes have opposing effects on the fairness of overall resource allocation. (1), the decline in approved claims for experimental medications, is beneficial. In contrast, (2), the increase in claims’ success rate, has a detrimental effect, because the majority of claims are still for extremely cost-ineffective medications. Finally, (3), the reform’s deterrent effect, is beneficial because it forestalls such low-priority spending. This paper argues that, taking all three effects into account, the reform has probably had a net positive impact on overall resource allocation. However, it also argues that there is a need for further reforms to lower the number of claims to low-priority medicines that are granted.

Item Type: Article
Official URL:
Additional Information: © 2019 The Authors
Divisions: Philosophy, Logic and Scientific Method
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited: 23 Oct 2019 09:30
Last Modified: 20 Nov 2019 12:44

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