Around 80% of the population depend exclusively on the SUS for getting their health careInsurance plans do not cover medicines, therefore insured patients pose a potential additional demand for medicines on the SUSAdditional refs: Viacava 2005, using results from the 2003 World Health Survey = 24% of adults (>18) have health insurance.
Ultimately, the present study aimed to inform the development of tools to more precisely estimate demand. This will be the next step in this research. Assess what has been done to lay the groundwork for the study and the development of better practices for prospective, longitudinal, long-term monitoring and follow-up of the demand and the capacity of the state in meeting it.
Measuring the Gap betweenDemand and Access in the Brazilian Public Health Care System Mariana Socal, MD, MPP June 25, 2012
Background• Around 76% of the Brazilian population depends exclusively on the public health system for obtaining health care services• Insured patients may also resort to the public health system in order to access treatments and services not covered in their health plans 2
Background• The benefits package of the Brazilian Public Health Care System includes free provision of medicines.• Insufficiencies in the provision of drugs may harm patients by preventing the initiation of treatment or by interrupting ongoing regimens. 3
Objectives• To review the existing evidence on the gap between demand and access to medicines within the Brazilian public health care system.• Estimating demand is the first step in order to allow for improvements in budget forecasting and public health planning.• Ultimately, this work aims to inform the development of tools to allow longitudinal and comprehensive estimation of demand and access 4
Method• Review of the literature through the Medline medical database (US National Library of Medicine). Keywords: Brazil, SUS, demand, access, utilization, medici nes, drugs. Review of reference lists of the identified articles.• Most of the selected studies drew data from national or regional population-based studies 5
Results• Near half of the adult population in Brazil utilizes medicines (Carvalho, 2005)• The utilization of medicines increases with age reaching more than 70% of individuals aged 60 years or older (Carvalho, 2005) Age group (years) p value 18-39 38.9 0.000 40-59 54.0 60 and over 73.0 6
Financing• Medicines are prescribed in more than 60% of medical consultations (Louvisson, 2008)• Although 61% of health consultations are publicly funded (Silva, 2011), around 70% of medicines are privately purchased (Louvisson, 2008) Medical Medicines Consultations Public Public Private Private 7
Gap in access• Around 8% of patients who receive a medical prescription are entirely unable to obtain the medicines they need (Louvisson, 2008).• Most frequently reported reasons (Carvalho, 2005): lack of financial conditions to purchase drugs (55%) lack of availability of medicines in public pharmacies (13%) 8
Major Reason 1: Price• Retail prices of essential medicines in Brazil: 1.9 times more expensive than Sweden 13.1 times more expensive than international unit-price indicators (Nóbrega, 2007)• The mean private expenditure with medicines per month compromises more than 20% of the income for at least 50% of the elderly (Lima-Costa, 2003). 9
Major Reason 2: Availability• The median availability of essential drugs in public pharmacies is 30% (Mendis, 2007). In private pharmacies the same drugs have median availability of 70%.• 65% of the essential medicines (RENAME) do not have a generic version available in the country (Miranda, 2010). 10
Equity Considerations• Less educated individuals are less likely to obtain treatment (Louvisson, 2008)• Out-of-pocket expenditures disproportionally affect the poorest (Ugá, 2007) Income decile 1 5 10 OOP as fraction (%) of 6.76 5.26 3.08 income Medicines as % of OOP 82.5 67.6 42 11
Discussion• The available evidence demonstrates limitations in the provision of medicines by the Brazilian public health care system.• Lack of public availability of drugs shifts the financial burden of medical treatment to users, compromising significant amounts of household income.• Individuals who cannot afford to buy medicines are disproportionally harmed, contributing to increased inequality. 12
Limitations• Nationwide data were not analyzed by region• Comparisons between levels of complexity (high-cost vs. essential medicines) or acute vs. chronic treatments were not performed• Cross-sectional data may limit the understanding of patterns across time 13
Conclusions• In order to increase availability of drugs in the Brazilian public health care system, improvements in budget forecasting and health planning are needed – Mechanisms for longitudinal data collection on access to medicines should be developed – Accounting for variations across regions, types of care and treatment complexity should be incorporated• Moving forward, empirical and epidemiologic evidence should be combined in order to inform development and implementation of pharmaceutical policies in the Brazilian public health system 14