Socioeconomic inequality in catastrophic health expenditure in Brazil

Boing, Alexandra Crispim; Bertoldi, Andréa Dâmaso; Barros, Aluísio J D; Posenato, Leila Garcia; Peres, Karen Glazer

doi:10.1590/s0034-8910.2014048005111

Cited by 51 publications

(72 citation statements)

References 19 publications

(39 reference statements)

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“…The medicines represent a high proportion of expenditure on health and, similarly, in this study they were present in most situations of CHE, with a higher catastrophic expenditure among the poorest, pattern observed in other studies 6 , 7 .…”

Section: Discussionsupporting

confidence: 88%

Catastrophic expenditure on medicines in Brazil

et al. 2016

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OBJECTIVE To describe the magnitude of the expenditure on medicines in Brazil according to region, household size and composition in terms of residents in a situation of dependency.METHODS Population-based data from the national household survey were used, with probabilistic sample, applied between September 2013 and February 2014 in urban households. The expenditure on medicines was the main outcome of interest. The prevalence and confidence intervals (95%CI) of the outcomes were stratified according to socioeconomic classification and calculated according to the region, the number of residents dependent on income, the presence of children under five years and residents in a situation of dependency by age.RESULTS In about one of every 17 households (5.3%) catastrophic health expenditure was reported and, in 3.2%, the medicines were reported as one of the items responsible for this situation. The presence of three or more residents (3.6%) and resident in a situation of dependency (3.6%) were the ones that most reported expenditure on medicines. Southeast was the region with the lowest prevalence of expenditure on medicines. The prevalence of households with catastrophic health expenditure and on medicines in relation to the total of households showed a regressive tendency for economic classes.CONCLUSIONS Catastrophic health expenditure was present in 5.3%, and catastrophic expenditure on medicines in 3.2% of the households. Multi-person households, presence of residents in a situation of economic dependency and belonging to the class D or E had the highest proportion of catastrophic expenditure on medicines. Although the problem is important, permeated by aspects of iniquity, Brazilian policies seem to be protecting families from catastrophic expenditure on health and on medicine.

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Section: Discussionsupporting

confidence: 88%

Catastrophic expenditure on medicines in Brazil

et al. 2016

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“…For instance, the catastrophic health expenditure (10 % or more of capacity to pay based on household consumption) was 18.4 % from the poorest and 17.7 % for the wealthiest in 2008–2009 [32]. However, rich and poor spend these funds in different ways.…”

Section: Discussionmentioning

confidence: 99%

Coverage and equity in reproductive and maternal health interventions in Brazil: impressive progress following the implementation of the Unified Health System

França

Restrepo‐Méndez

Maia

et al. 2016

Int J Equity Health

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BackgroundThe Brazilian SUS (Unified Health System) was created in 1988 within the new constitution, based on the premises of being universal, comprehensive, and equitable. The SUS offers free health care, independent of contribution or affiliation. Since then, great efforts and increasing investments have been made for the system to achieve its goals. We assessed how coverage and equity in selected reproductive and maternal interventions progressed in Brazil from 1986 to 2013.MethodsWe reanalysed data from four national health surveys carried out in Brazil in 1986, 1996, 2006 and 2013. We estimated coverage for six interventions [use of modern contraceptives; antenatal care (ANC) 1+ visits by any provider; ANC 4+ visits by any provider; first ANC visit during the first trimester of pregnancy; institutional delivery; and Caesarean sections] using standard international definitions, and stratified results by wealth quintile, urban or rural residence and country regions. We also calculated two inequality indicators: the slope index of inequality (SII) and the concentration index (CIX).ResultsAll indicators showed steady increases in coverage over time. ANC 1+ and 4+ and institutional delivery reached coverage above 90 % in 2013. Prevalence of use of modern contraceptives was 83 % in 2013, indicating nearly universal satisfaction of need for contraception. On a less positive note, the proportion of C-sections has also grown continuously, reaching 55 % in 2013. There were marked reductions in wealth inequalities for all preventive interventions. Inequalities were significantly reduced for all indicators except for the C-section rate (p = 0.06), particularly in absolute terms (SII).ConclusionsDespite the difficulties faced in the implementation of SUS, coverage of essential interventions increased and equity has improved dramatically, due in most cases to marked increase in coverage among the poorest 40 %. An increase in unnecessary Caesarean sections was also observed during the period. Further evaluation on the quality of healthcare provided is needed.

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“…In Brazil, total expenditures on health services accounted for 5.5% of the Gross Domestic Product (GDP) and total expenditures on medicines accounted 1.9% of GDP in [4]. Data from the most recent household expenditures survey shows that health is the fourth most important expenditure category, after housing, food and transportation; medicines accounted for about 47% of total household expenditures on health, with higher expenditure burden among the poorest [5]. …”

Section: Introductionmentioning

confidence: 99%

Farmácia Popular Program: changes in geographic accessibility of medicines during ten years of a medicine subsidy policy in Brazil

Emmerick

Nascimento

Pereira

et al. 2015

J of Pharm Policy and Pract

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ObjectivesThe Brazilian constitution guarantees the right to health, including access to medicines. In May 2004, Brazil’s government announced the “Farmácia Popular” Program (FPP) as a new mechanism to improve the Brazilian population’s access to medicines. Under FPP, a selected list of medicines is subsidized by the government and provided in public and private pharmacies.The aim of this study is to describe the historical stages of the FPP and to identify associated changes in the geographical accessibility of medicines through the FPP over time.MethodsIt was performed documentary review and an ecological study assessing program coverage in terms of number of facilities and a FPP Pharmacy Facilities Density (PFD) index at national and regional levels from 2004 to 2013, using the FPP database. We used geographic information system mapping to depict a pharmaceutical facilities density (PFD) index at the municipality level on thematic maps.ResultsA growth of the PFD index coincident with the phases of the FPP was noticed. In the public sector, the program started in 2004; by 2006, there was a sharp increase in the numbers of participating pharmacies, stabilizing in 2009. In the private sector, the program started in 2006; by 2009 the PFD ratio had increased substantially and it continued to grow through 2011. There was an increase in FPP coverage in most regions between 2006, when the private pharmacy component started, and 2013, but participating pharmacies remain unequally distributed across geographical regions. Specifically, the wealthy areas in the South and Southeast have higher coverage, with lower coverage mostly in the North and Northeast, relatively poorer areas with greater need for access to medicines, health care, and other basic services such as potable water and sanitization.ConclusionsThere has been a substantial increase in the number of pharmacies participating in the FPP over time. This has led to greater program coverage and has potentially improved access to FPP medicines in the country. Nevertheless, disparities in pharmacy coverage remain among the regions.Electronic supplementary materialThe online version of this article (doi:10.1186/s40545-015-0030-x) contains supplementary material, which is available to authorized users.

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Socioeconomic inequality in catastrophic health expenditure in Brazil

Cited by 51 publications

References 19 publications

Catastrophic expenditure on medicines in Brazil

Catastrophic expenditure on medicines in Brazil

Coverage and equity in reproductive and maternal health interventions in Brazil: impressive progress following the implementation of the Unified Health System

Farmácia Popular Program: changes in geographic accessibility of medicines during ten years of a medicine subsidy policy in Brazil

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