Catastrophic expenditure on medicines in Brazil.

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

doi:10.1590/s1518-8787.2016050006172

Abstract

ABSTRACTOBJECTIVE 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.

Highlights

The medicines are essential health inputs and determinants in the good outcome of a large number of diseases and harms to health, including the increased survival rate and relief of suffering.Many countries face serious problems of access both to health services and to medicines[23]
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

Summary

Introduction

Many countries face serious problems of access both to health services and to medicines[23]. Both indicators tend to be high in many countries, even among vulnerable groups, to a greater magnitude in groups of higher income[23]. Wagner et al, reviewing data from 70 countries, showed that between 93.0% and 100% of individuals reported getting health care and from 72.0% to 83.0% all or almost all of them managed to get the medicines they sought for the last 12 months[24]. Study in four Central American countries showed that 79.1% of individuals found access to medicines (sought and obtained)[1]. Facing the need to use medicines, even if expensive, users are compelled to dispose of property or resort to justice to demand them, in order to ensure continuity of treatment and the mitigation of their suffering

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Discussion

Conclusion