Health Mediation: A New Perspective on Health Conflict Resolution

In health law, we tend to speak about regulations and court rulings. But behind every case file, there is something more: a story, an emotion, and, above all, a person. In health-related conflicts, the challenge is no longer simply to resolve according to the law, but to arrive at the resolution in a way that restores trust in the system.

In recent years, the systematic judicialization of health rights has revealed its limits: overloaded case files, lengthy processes, and responses that do not always repair what was broken. Judicialization has also come to function as an escape valve in the system — an avenue for accessing health benefits not covered through social insurance.

Mediation in health care can help. According to conflict resolution specialist Christopher W. Moore, mediation is the intervention in a negotiation or a conflict of an impartial and neutral third party who has no authoritative decision-making power, but who assists the parties in voluntarily reaching a mutually acceptable settlement of issues in dispute.

Many conflicts in health care arise from deficient communication between providers and patients, and that gap is precisely where health mediation finds its deepest meaning. Outcomes depend not only on technical precision but also on the human quality of the interaction.

Here is a look at how alternative dispute resolution has been successful in Chile, Spain, and Argentina:

Chile: In Chile, the Law on Universal Access with Explicit Guarantees (AUGE in Spanish) incorporated early resolution mechanisms for health conflicts. In 2004, the AUGE Plan established the requirement of mediation before filing a liability claim for damages.

Using this system, agreements in mediation cases include apologies and explanations of the facts. In 2024, 49.8 percent of agreements did not involve the payment of compensation, but rather interventions based on dialogue and communication.

Spain: In Spain, the Health Mediation Units (UMS in Spanish) were developed through the Mediation Observatory of the University of Barcelona. 

UMS is based on training health professionals in mediation and opening mediation units throughout the public health system. With more than 20 years of experience, they now play a key role within the Catalan Institute of Health, covering the entire population, as well as other pioneering services.

Results from these mediation units in Spain show that while this is not a magic bullet, it is a viable institutional policy, which can restore trust in the health system.

Argentina: Argentina created the Prejudicial Mediation Procedure in Health Matters (PROMESA in Spanish) in June 2025.

The amparo, a protection writ for vindicating constitutional rights has been essential for guaranteeing health rights, but the adversarial nature of litigation  is not always the most suitable space to address conflicts involving pain, uncertainty, and people’s individual life plans. Courts should not be the health lawyer’s first tool, but rather the last step in efforts to defend a client’s interests.

PROMESA was conceived as an institutional anticipation policy aimed at preventing harm; a tool to guarantee rights and restore trust; and a space where legal, clinical, and human reasoning are integrated. The Superintendency of Health Services, dependent from National Ministry of Health, recently reported the first agreement in which this state agency participated as a party.

This framework offers a new mechanism for managing conflicts between users and providers/insurers, which is based on the principles of voluntariness, confidentiality, and promptness. Its purpose is to offer an alternative that is faster, less costly, and more humane than litigation. 

Risks of health mediation 

Within complex and fragmented health systems, conflicts are inevitable. These spaces are characterized by high existential or emotional vulnerability. As a mediator since 2012, I have found out that every time a dispute is addressed through mediation, trust is rebuilt. And trust, in health contexts, is worth more than a favorable ruling.

For this reason, drawing from comparative experience, we can affirm that when the dynamic of alternative dispute resolution is strengthened, mediation becomes a tool capable of reducing conflict without weakening the rights at stake.

However, health mediation also faces risks. For example, bureaucratization can occur if this procedure becomes slow; or institutional capture, if a particular sector—such as insurers or the pharmaceutical industry—attempts to take over the process, among others. Moreover, in countries where there is a widespread lack of trust in the government, the success or failure of the mediation mechanism is significantly affected. Clear principles, continuous training, and appropriate monitoring, which are contemplated in the Argentine procedure, may be able to mitigate some of these risks.

My interest in this topic stems from a family experience. My grandmother Blanca faced enormous difficulties in accessing her medication after being diagnosed with leukemia. Her judicial experience, linked to delay in deliver cancer drugs and breaches from social insurance (obra social), shaped the course of my profession and taught me something essential: Every legal decision in health has profound implications for an individual’s life course. For this reason, there is an urgent need to adopt a different approach.

Health mediation reminds us that behind every claim there is a story and an expectation, as in Blanca’s case. The true achievement is not to win a case, but to promote the patient care, which is one of the core principles of health law.

Note: Some key legal materials are available only in Spanish. To request additional information or translations, please contact Ana Inés Diaz at adiaz.mdp@gmail.com