health policy, civil law courts in Latin America have recently emerged as an extremely active retail redress procedure. In Brazil, over the last decade, there have been estimated 100,000 cases in which courts have reviewed whether individuals received medical treatments (mostly medications) to which they were arguably entitled under the terms of the 1988 Constitution and the operational guidelines of the SUS. The state of Sao Paulo alone spent around US$130 million in 2007 to comply with judicial orders.<sup>67</sup> Figure 1 below illustrates the recent explosion in health cases in the courts of some Brazilian states – generally, in the relatively wealthier south and southeastern states. Similarly, the Colombian courts heard more than 142,000 claims regarding health cases (mostly, that health insurers had unfairly denied them treatments or medications) in 2008 alone.<sup>68</sup> In Costa Rica, there have been a larger number of constitutional claims against the social security agency (CCSS), and overall personal clams have increased every year since 1997.<sup>69</sup> In all three of these countries, claimants have won the large majority of cases, but there have been concerns that the middle class individuals have availed themselves of judicial redress much more frequently than the most marginalized individuals and groups.

Another retail model is court-administered mediation or alternative dispute resolution. In India‘s common law system, the courts have played an important role in creating new venues for redress. In a significant ruling, the Indian Supreme Court allowed patients to use Consumer Protection Courts, in addition to ordinary courts, to obtain compensation and redress in cases involving medical malpractice.<sup>70</sup> The Indian courts also oversee alternative dispute resolution forums known as ―People‘s Courts‖ ( _Lok Adalats_ ) in which redress claims from a variety of sources are subject to judge supervised mediation. There is concern, however, about the effectiveness of these forums.<sup>71</sup> In the UK, the recent Law Commission report has sparked a debate about the use of alternative dispute resolution to address administrative redress.<sup>72</sup> Specialized courts can also be used to handle redress claims at the retail level. In Switzerland, the Federal Insurance Court, located in Lucerne, is responsible for social insurance law as part of administrative law. As a court of last resort, it renders judgment on appeals of decisions by cantonal insurance courts and by other authorities in federal insurance cases.<sup>73</sup>

> 67 Octavio Ferraz, Right to Health Litigation in Brazil: An Overview of the Research, SSRN Working Paper, May 15 2009.

> 68 Alicia Ely Yamin and Oscar Parra-Vera, Judicial Protection of the Right to Health in Colombia: From Social Demands to Individual claims to Public Debates, _Hastings International and Comparative Law Review_ 33:2 2010 69 Bruce Wilson, Rights Revolutions in Unlikely Places: The Cases of Colombia and Costa Rica, forthcoming Journal of Politics in Latin America 2/2009: 59-85.

> 70  Indian Medical Association v. V P Shantha AIR 1996 SC 550: (1995) 6 SCC 651

> 71 Marc Galanter and Jayanth K. Krishnan, Brad  for the Poor: Access to Justice and the Rights of the Needy in India, _Hastings Law Journal_ 55 2004 p. 789

> 72 Administrative Redress: Public Bodies and the Citizen, A Consultation Paper, The Law Commission, Consultation Paper No. 187. Available at www.lawcom.gov.uk/docs/cp187_web.pdf _<u>.</u>_ See also Kirkham, Richard(2008) 'Quiet Moves Toward Proportionate Dispute Resolution: The Law Commission's Consultation Paper on Administrative Redress', Journal of Social Welfare and Family Law, 30: 2, 163 — 174; and Mullender, Richard (2009) ―Negligence, Public Bodies and Ruthlessness,‖ The Modern Law Review,

> 73 <u>http://www.bger.ch</u>

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