Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Av. Plaza 680, Las Condes, Santiago, Chile.
Nous Comunicación y Estrategia, Santiago, Chile.
BMC Health Serv Res. 2024 Nov 19;24(1):1436. doi: 10.1186/s12913-024-11900-5.
Access to medicines is one of the most serious public health problems globally, and Chile is not an exception. The aim of this study was to explore patients' perceptions, beneficiaries of both public and private health sectors, of barriers and facilitators in access to medicines in general, and those associated with the treatment of diabetes, dyslipidemia and hypertension.
Ten focus groups of patients with these diseases, diagnosed for at least six months and with prescribed medication, were carried out in five regions of Chile: Arica (north), Aysén (south), and Valparaíso, Metropolitan, and Maule (center).
The experience of access to medicines is determined by the insurance system, the experience of care with public or private providers, and geographical-administrative difference between capital and other regions. Beneficiaries of public sector value territorial coverage of primary care, which guarantees access in isolated areas and, despite their greater socioeconomic vulnerability, perceive greater protection in access (access conditions, delivery reliability and adherence to pharmacological treatment). The main problem observed is the financing of treatments not covered by the system. Beneficiaries of private sector perceive that they have access to medicines of better quality than those provided free of charge by public sector, but raise fears associated with the inability to afford them and distrust in the market process. Regarding the type of provider, public sector shows greater capacity for user loyalty, which is expressed in regular visits and follow-up, unlike discontinuous examinations among private sector beneficiaries.
Different access conditions both at the territorial level and in the health subsystems are evident. It is necessary to make progress in addressing the problem of access to medicines in a comprehensive manner.
药品可及性是全球最严重的公共卫生问题之一，智利也不例外。本研究旨在探讨患者对公共和私营卫生部门在药品可及性方面的障碍和促进因素的看法，以及与糖尿病、血脂异常和高血压治疗相关的因素。
在智利五个地区（阿里卡[北部]、阿伊森[南部]和瓦尔帕莱索、大圣地亚哥和马乌莱[中部]）开展了针对这些疾病的十个患者焦点小组，这些患者的诊断时间至少为六个月，且有处方药物。
药品可及性的体验取决于保险制度、与公共或私人提供者的护理体验以及首都和其他地区之间的地理行政差异。公共部门的受益者重视初级保健的地域覆盖范围，这确保了在偏远地区的可及性，尽管他们的社会经济脆弱性更大，但他们认为在可及性方面（获得条件、交付可靠性和遵守药物治疗）受到更大的保护。观察到的主要问题是治疗费用由系统覆盖。私营部门的受益者认为他们能够获得比公共部门免费提供的质量更好的药物，但他们担心自己无法负担得起这些药物，并且对市场过程缺乏信任。关于提供者的类型，公共部门表现出对用户忠诚度的更大能力，这表现在定期就诊和随访中，而私营部门的受益者则没有这种连续性检查。
在地域层面和卫生子系统中都存在不同的可及性条件。有必要在全面解决药品可及性问题方面取得进展。
