Universidade Federal de Santa Catarina. Programa de Pós-Graduação em Saúde Coletiva. Florianópolis, SC, Brasil.
Simon Fraser University. Faculty of Health Sciences. Burnaby, BC, Canada.
Rev Saude Publica. 2024 Aug 9;58:34. doi: 10.11606/s1518-8787.2024058005986. eCollection 2024.
To estimate the prevalence of general and public access to prescription drugs in the Brazilian population aged 15 or older in 2019, and to identify inequities in access, according to intersections of gender, color/race, socioeconomic level, and territory.
We analyzed data from the 2019 National Health Survey with respondents aged 15 years or older who had been prescribed a medication in a healthcare service in the two weeks prior to the interview (n = 19,819). The outcome variable was access to medicines, subdivided into general access (public, private and mixed), public access (via the Unified Health System - SUS) for those treated by the SUS, and public access (via the SUS) for those not treated by the SUS. The study's independent variables were used to represent axes of marginalization: gender, color/race, socioeconomic level, and territory. The prevalence of general and public access in the different groups analyzed was calculated and the association of the outcomes with the aforementioned axes was estimated with odds ratios (OR) using logistic regression models.
There was a high prevalence of general access (84.9%), when all sources of access were considered, favoring more privileged segments of the population, such as men, white, and those of high socioeconomic status. When only the medicines prescribed in the SUS were considered, there was a low prevalence (30.4% access) that otherwise benefited marginalized population segments, such as women, black, and people from low socioeconomic backgrounds.
Access to medicines through the SUS proves to be an instrument for combating intersectional inequities, lending credence to the idea that the SUS is an efficient public policy for promoting social justice.
估计 2019 年巴西 15 岁及以上人群中普遍获得处方药物的情况，并根据性别、肤色/种族、社会经济水平和地区的交叉情况，确定获得药物的不平等情况。
我们分析了 2019 年全国健康调查的数据，该调查的受访者年龄在 15 岁及以上，在接受采访前两周内曾在医疗服务中开处方药（n=19819）。因变量是获得药物的情况，分为一般获得（公共、私人和混合）、公共获得（通过统一卫生系统-SUS 为接受 SUS 治疗的人提供）和公共获得（通过 SUS 为未接受 SUS 治疗的人提供）。本研究的自变量用于表示边缘化的轴：性别、肤色/种族、社会经济水平和地区。在分析的不同群体中计算了一般和公共获得的流行率，并使用逻辑回归模型估计了结果与上述各轴之间的关联，用优势比（OR）表示。
当考虑所有获得途径时，普遍获得（84.9%）的比例很高，这有利于人口中更享有特权的群体，如男性、白人以及社会经济地位较高的人。当只考虑在 SUS 开的药时，获得的比例较低（30.4%的人获得），这有利于边缘化的人群群体，如女性、黑人以及社会经济背景较低的人。
通过 SUS 获得药物被证明是一种消除交叉不平等的手段，这证明了 SUS 是促进社会正义的有效公共政策。
