Abstract
BackgroundAccess to medicines is one of the major challenges in health policy. The high out-of-pocket expenditures on medicines in the Latin American and Caribbean (LAC) region represents important barrier to affordable access to care for NCDs. This paper aim to identify key barriers in access to medicines for household members with a diagnosed chronic condition in three Central America countries.MethodsThis was a cross-sectional analytic study, based on data from three household surveys using a common methodology. We examined associated factors to: (1) seeking care for chronic illness from a trained clinician in the formal health system, and (2) obtaining all medicines sought for the chronic conditions reported.ResultsA chronic condition was reported in 29.8 % (827) of 2761 households - 47.0, 30.7 and 11.8 % in Nicaragua, Honduras and Guatemala, respectively. The three main chronic conditions reported were hypertension, arthritis, and diabetes. Seeking care in the formal health system ranged from 73.4 % in Nicaragua to 83.1 % in Honduras, while full access to medicines varied from 71.6 % in Guatemala to 88.0 % in Honduras. The main associated factors of seeking care in the formal health system were geographic location, household head gender, Spanish literacy, patient age, perceived health status, perceived quality of public sector care, household economic level, and having health insurance. Seeking care in the formal health system was the main bivariate associated factor of obtaining full access to medicines (OR: 4.3 95 % CI 2.6 – 7.0). The odds of full access to medicines were significantly higher when the household head was older than 65 years, medicines were obtained for free, households had higher socioeconomic status, and health care was sought in the private sector.ConclusionsThe nature of the health system plays an important role in access to medicines. Access is better when public facilities are available and function effectively, or when private sector care is affordable. Thus, understanding how people seek care in a given setting and strengthening key health system components will be important strategies to improve access to medicines, especially for populations at high risk of poor access.
Highlights
Access to medicines is one of the major challenges in health policy
Study variables We examined two key outcome measures: "seeking care in the formal health system" and “having full access to medicines” for a chronic condition
Overall, only about three-quarters of persons who reported a chronic condition sought care in the formal health system, ranging from 73.4 % in Nicaragua to 83.1 % in Honduras (Table 2). Of those who sought care in the formal health system, almost all were successful in obtaining health care and they were more likely to have “full access to medicines” for their chronic illness, (p
Summary
Access to medicines is one of the major challenges in health policy. Ensuring access to medicines for people who need them is one of the major challenges in health policy, especially for non-communicable diseases (NCDs) [2, 3]. NCDs, such as cardiovascular disease, diabetes, cancer, and chronic respiratory diseases, are the leading causes of premature death and illness throughout the Americas. They account for some 4.5 million deaths each year in Latin America and the Caribbean, or 77 % of all deaths in the Region [2, 4, 5]
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