Chapter 6: Riding a second wave (2000-2020): the downstream approach and the rise of high-cost patients
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Chapter 6 (Riding a second wave (2000-2020): the downstream approach and the rise of "high-cost patients") argues that the early 1990s HIV/AIDS litigation, conducted by support structures of rights-advocacy lawyers and civil society organizations similar to those that prompted a rights-based legal mobilization in the United States during the 1970s, is no longer an appropriate framing to account for the accumulation of thousands of lawsuits clustering around individual demands for medications and treatments. But more importantly, in this chapter I contend that the downstream approach to litigation centered on the demand for costly drugs casts serious doubts about the transformative potential of the judicialization of health care in Colombia and Brazil, where the litigation epidemic of the right to health is having deleterious effects on public budgets and on the government's ability to allocate scarce health resources.

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