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

Tavares, Noemia Urruth Leão; Luiza, Vera Lucia; Oliveira, Maria Auxiliadora; Costa, Karen Sarmento; Mengue, Sotero Serrate; Arrais, Paulo Sergio Dourado; Ramos, Luiz Roberto; Farias, Mareni Rocha; Pizzol, Tatiane da Silva Dal; Bertoldi, Andréa Dâmaso

doi:10.1590/S1518-8787.2016050006118

Brasil

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Original Articles • Rev. Saúde Pública 50 (suppl 2) • 12 Dec 2016 • https://doi.org/10.1590/S1518-8787.2016050006118 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

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.

Medicines; Equity in Access; Chronic Disease; National Drug Policy; Health Surveys

Variable	Prevalence of free access to all medicines

	%^a	95%CI	P^b
Demographic Characteristics

Sex			< 0.001
Male	51.4	48.1–54.8
Female	45.3	42.9–47.8
Age (years)			0.001
20-39	41.2	35.9–46.8
40-59	51.1	48.1–54.2
≥ 60	46.0	43.0–49.0

Socioeconomic characteristics

Education (years of schooling)			0.933
0-8	47.5	44.6–50.6
9-11	47.0	43.7–50.4
≥ 12	47.9	43.6–52.2
Economic classification (ABEP)^c			< 0.001
A/B	35.8	32.6–39.2
C	50.5	47.7–53.3
D/E	53.9	50.2–57.7
Region of the country			0.074
North	53.0	47.0–58.9
Northeast	43.4	40.1–46.7
Southeast	49.0	44.8–53.3
South	47.8	44.0–51.6
Midwest	44.8	41.1–48.5
Has health plan			< 0.001
Yes	27.6	24.9–30.5
No	55.7	53.1–58.1

Total	47.5	45.1–50.0

ATC classification levels 1 and 2	Funding source of the medicine

	% paid^b	95%CI	% free^b	95%CI
A: Digestive apparatus and metabolism
A10 Medicine used for diabetes	21.4	18.7–24.4	78.6	75.6–81.3
C: Cardiovascular system
C01 Cardiac therapy	56.2	49.5–62.6	43.8	37.4–50.5
C02 Antihypertensives	50.4	41.7–59.1	49.6	40.9–58.3
C03 Diuretics	22.0	19.5–24.8	78.0	75.2–80.5
C07 Beta-blockers	37.3	34.2–40.6	62.7	59.4–65.8
C0 Calcium channel blockers	41.4	36.3–46.7	58.6	53.3–63.7
C09 Agents acting on the renin-angiotensin system	26.6	24.2–29.2	73.4	70.8–75.8
C10 Lipids modifier agents	44.6	40.7–48.6	55.4	51.4–59.3
N: Nervous system
N06 Psychoanaleptics	41.5	37.5–45.6	58.5	54.4–62.5
N03 Antiepileptics	41.2	36.0–46.7	58.8	53.3–64.0
N05 Psycholeptics	45.3	39.1–51.6	54.7	48.4–60.9
N04 Antiparkinson	26.4	17.2–38.2	73.6	61.8–82.8
R: Respiratory system
R03 Agents against airway obstructive diseases	60.0	52.7–66.9	40.0	33.1–47.3
R06 Antihistamines for systemic use	56.6	43.3–69.1	43.4	30.9–56.7

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[1] Correspondence: Noemia Urruth Leão Tavares Campus Darcy Ribeiro s/n 70910-900 Brasília, DF, Brasil E-mail: nul.tavares@gmail.com