Strategic circumvention of regulations: the judicialization of the Brazilian private health system

• Main Authors: ARNALDO L. RYNGELBLUM, PAULO C. DUARTE de OLIVEIRA, RENATO TELLES, MAYLA C. COSTA
• Format: Article
• Language: English
• Published: Fundação Getulio Vargas, Escola Brasileira de Administração Pública e de Empresas
• Series: Cadernos EBAPE.BR
• Subjects: Teoría institucional; Salud; Regulación; Justicia; Estrategia
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1679-39512019000300623&lng=en&tlng=en

Abstract The article aims to advance the understanding of the successive circumvention of regulations by organizations, to determine whether it is possible to characterize them as purposeful actions, while the institutional literature analyzes decoupling and circumvention as sporadic activities. It analyzes the responses adopted by health plan companies to favor their interests, responses that often fail to comply with the rules of the institutional context, and which boosted the phenomenon known as ‘judicialization’. The study analyzed 158 lawsuits collected from the electronic archives of the Court of Justice of São Paulo, where beneficiaries sue health plan companies because of treatment coverage denial. Using correspondence and thematic analysis, some associations between denials and allegations showed to be significant, suggesting companies’ strategic patterns. It was possible to identify different strategic practices adopted by companies to avoid complying with institutional guidelines, and to observe that certain regulatory features can contribute to non-compliance strategies. The article contributes to the institutional literature by identifying organizational practices meant to successively circumvent and confront institutional prescriptions, indicating that health plan companies apparently design specific strategies to respond to beneficiaries’ demands.