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Master's Dissertation
DOI
10.11606/D.5.2006.tde-02062006-105722
Document
Author
Full name
Mario César Scheffer
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2006
Supervisor
Committee
Elias, Paulo Eduardo Mangeon (President)
Malik, Ana Maria
Nunes Junior, Vidal Serrano
Title in Portuguese
"Os planos de saúde nos tribunais: uma análise das ações judiciais movidas por clientes de planos de saúde, relacionadas à negação de coberturas assistenciais no Estado de São Paulo"
Keywords in Portuguese
Cobertura de serviços privados de saúde
Poder Judiciário
Prestação de cuidados de saúde
Abstract in Portuguese
O estudo Os Planos de Saúde nos Tribunais trata das ações judiciais relacionadas à cobertura assistencial de planos de saúde julgadas em segunda instância pelo Tribunal de Justiça do Estado de São Paulo entre janeiro de 1999 e dezembro de 2004. São descritas e analisadas as demandas levadas ao Poder Judiciário por usuários de planos de saúde que reclamam negação de assistência ou restrição de atendimento. Também é avaliado o comportamento e as argumentações da Justiça nas decisões, assim como as possíveis implicações da exclusão de coberturas praticadas pelos planos de saúde para o sistema de saúde brasileiro
Keywords in English
Delivery of health care
Judicial power
Private medical coverage
Abstract in English
This paper is about lawsuits filed against HMOs over coverage issues and ruled on by the São Paulo State the implications that HMO exclusions and limitations may have for the Brazilian health care system Court of Appeals between January 1999 and December 2004. Enrollees' legal claims against HMOs for denial of medical care or restrictions on services are described and analyzed here. Also assessed are the attitudes and arguments behind court decisions, as well as the implications tha HMO exclusions and limitations may have for the Brazilian health care system.
 
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MarioScheffer.PDF (490.28 Kbytes)
Publishing Date
2006-06-08
 
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