Judicialization of Autism Spectrum Disorder Treatments in Supplementary Health: Analysis of Judgments Delivered by the São Paulo Court of Justice in 2023

Abstract

Despite the economic, legal, and social relevance of the topic, the judicialization of treatments for autism spectrum disorder in Brazil has yet to be explored in depth in academic literature. To fill this gap, a systematic content analysis was conducted on a representative sample of judgments issued by the São Paulo State Court (TJSP) in 2023. The plaintiffs were predominantly very young children, with an average age of approximately six years and a median age of four years and ten months. The main treatments sought were consultations with speech therapists, occupational therapists, and psychologists. In 66% of the cases, there was a request for a professional trained in the Applied Behavior Analysis technique. The main arguments presented by health insurance operators were related to legal discussions about the obligation to cover the requested treatments. On the other hand, the primary argument used by the judges was that neither the judge nor the operator could review the prescription provided by the patient's doctor. To substantiate their decisions, judges primarily relied on the court's jurisprudence, binding precedents from the TJSP, and the Brazilian Consumer Protection Code. The total or partial success rate for patients was 92%.