Acesso a medicamentos no setor público: análise de usuários do Sistema Único de Saúde no Brasil

Boing, Alexandra Crispim; Bertoldi, Andréa Dâmaso; Boing, Antônio Fernando; Bastos, João Luiz; Peres, Karen Glazer

doi:10.1590/s0102-311x2013000400007

Cited by 42 publications

(75 citation statements)

References 24 publications

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“…In the case of medicines, studies have generally found high rates of access 19 , but while most health care is obtained from the Brazilian Unified Health System (SUS) 22 , most medicines are obtained from the private sector 8 , 17 . 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: 74%

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: 74%

Catastrophic expenditure on medicines in Brazil

et al. 2016

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“…Regarding the differences in the five regions of the Country, the Northeast region showed the lowest prevalence of free access to all medicines, which has been observed in prior studies 7 , 21 . Considering that, in the Northeast region, 78.0% of cities have low Human Development Index (HDI) of Income b and that the income expenditure on purchasing medicines can be almost three times higher among the poorest (7.3%), when compared to the richest (2.7%) 6 , these results may indicate that the population of this region is more vulnerable to treatment discontinuation because of inability to pay for treatment with medicines for chronic diseases 11 .…”

Section: Discussionsupporting

confidence: 61%

“…The poorest had greater free access to all medicines to treat chronic diseases, strengthening the hypothesis that SUS is promoting equity in access to medicines 19 . This finding is important, considering the inverse association between socioeconomic position and under-utilization of medicines, and that, in these population sectors, the public health system is often the only alternative to enable the needed therapy 6 , 7 , 14 .…”

Section: Discussionmentioning

confidence: 75%

“…PNAD assessed the population that had medicines prescribed in SUS, of which 45.3% obtained them in the public system 7 . We need caution when comparing these data, given that PNAD analyzed only the access of prescriptions from SUS, and this study examined all sources; however, both results indicate that about half of the Brazilian population gets free access to treatment since 2008.…”

Section: Discussionmentioning

confidence: 99%

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Free access to medicines for the treatment of chronic diseases in Brazil

et al. 2016

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OBJECTIVE To analyze the free access to medicines for the treatment of chronic diseases in the Brazilian population, according to demographic and socioeconomic factors. We also analyzed the most used pharmacological groups, according to funding source: free-of-charge or out-of-pocket paid.METHODS Analysis of data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based household survey, of cross-sectional design, based on probabilistic sample of the Brazilian population. We analyzed as outcome the prevalence of free access (free-of-charge) to all medicines for treatment of the reported chronic diseases, in the last 30 days. We studied the following independent variables: sex, age group, education in complete years of school, economic class, health plan, and geographical region of residence. We estimated the prevalences and 95% confidence intervals (95%CI) and applied the Pearson’s Chi-squared test to assess the differences between the groups, considering a 5% significance level.RESULTS About half of adults and older adults who have had full access to the treatment of chronic diseases in Brazil obtained all needed medicines for free (47.5%; 95%CI 45.1–50.0). The prevalences of free access were higher among men (51.4%; 95%CI 48.1–54.8), age group of 40-59 years (51.1%; 95%CI 48.1–54.2), and in the poorest social classes (53.9%; 95%CI 50.2–57.7). The majority of medicines that act on the cardiovascular system, such as diuretics (C03) (78.0%; 95%CI 75.2–80.5), beta-blockers (C07) (62.7%; 95%CI 59.4–65.8), and the agents that work in the renin-angiotensin system (C09) (73.4%; 95%CI 70.8–75.8), were obtained for free. Medicines that act on the respiratory system, such as agents against obstructive airway diseases (R03) (60.0%; 95%CI 52.7–66.9) were mostly paid with own resources.CONCLUSIONS Free access to medicines for treatment of chronic diseases occurs to a considerable portion of the Brazilian population, especially for the poorest ones, indicating decreased socioeconomic inequalities, but with differences between regions and between some classes of medicines.

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“…Difficulties in access to medicines due to their high share in private household spending in Brazil 16 and supply problems in public units of the Brazilian Unified Health System (SUS) 2 justified the introduction of Farmácia Popular Program (PFPB) by the Brazilian Ministry of Health (MH) in 2004 13 . Its creation, however, did not alter the responsibilities of municipalities in the provision of medicines from SUS.…”

Section: Introductionmentioning

confidence: 99%

Costs of Public Pharmaceutical Services in Rio de Janeiro Compared to Farmácia Popular Program

Silva

Caetano

2016

Rev. Saúde Pública

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OBJECTIVE To analyze the costs of public pharmaceutical services compared to Farmácia Popular Program (Popular Pharmacy Program).METHODS Comparison between prices paid by Aqui Tem Farmácia Popular Program (Farmácia Popular is available here) with the full costs of medicine provision by the Municipal Health Department of Rio de Janeiro. The comparison comprised 25 medicines supplied by both the municipal pharmaceutical service and Aqui Tem Farmácia Popular Program. Calculating the cost per pharmaceutical unit of each medicine included expenditure by Municipal Health Department of Rio de Janeiro with procurement (price), logistics, and local dispensation. The reference price of medicines paid by Aqui Tem Farmácia Popular was taken from the Brazilian Ministry of Health standard in force in 2012. Comparisons included full reference price; reference price minus 10.0% copayment by users; and maximum reference paid by the Ministry of Health (minus copayment and taxes). Simulations were carried out of the differences between the costs of Municipal Health Department of Rio de Janeiro with the common medicines and those potentially incurred based on the reference price of Aqui Tem Farmácia Popular.RESULTS The Municipal Health Department of Rio de Janeiro spent R$28,526,526.57 with 25 medicines of the common list in 2012; 58.7% accounted for direct procurement costs. The estimated costs of the Health Department were generally lower than the reference prices of the Aqui Tem Farmácia Popular Program for 20 medicines, regardless of reference prices. The potential costs incurred by Health Department if expenditure of its consumption pattern were based on the reference prices of Aqui Tem Farmácia Popular would be R$124,170,777.76, considering the best scenario of payment by the Brazilian Ministry of Health (90.0% of the reference price, minus taxes).CONCLUSIONS The difference in costs between public provision by Municipal Health Department of Rio de Janeiro and Farmácia Popular Program indicates that some reference prices could be reviewed aiming at their reduction.

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Acesso a medicamentos no setor público: análise de usuários do Sistema Único de Saúde no Brasil

Cited by 42 publications

References 24 publications

Catastrophic expenditure on medicines in Brazil

Catastrophic expenditure on medicines in Brazil

Free access to medicines for the treatment of chronic diseases in Brazil

Costs of Public Pharmaceutical Services in Rio de Janeiro Compared to Farmácia Popular Program

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