目标:估计2019年巴西15岁或15岁以上人口中一般和公众获得处方药的流行率,并确定获得方面的不平等。根据性别的交叉点,颜色/种族,社会经济水平,和领土。
方法:我们分析了2019年全国健康调查的数据,调查对象年龄在15岁或以上,他们在采访前两周在医疗服务机构开了药(n=19,819)。结果变量是获得药物,细分为一般访问(公共,私人和混合),对接受SUS治疗的人进行公共访问(通过统一卫生系统-SUS),和公共访问(通过SUS)为那些不受SUS治疗的人。研究的自变量用于表示边缘化轴:性别,颜色/种族,社会经济水平,和领土。计算了不同组的一般和公共访问的患病率,并使用逻辑回归模型用比值比(OR)估计了结果与上述轴的关联。
结果:一般接入率很高(84.9%),当考虑到所有访问来源时,有利于更有特权的人群,比如男人,白色,以及社会经济地位高的人。当只考虑SUS中规定的药物时,患病率低(30.4%),否则会使边缘化人群受益,比如女人,黑色,和来自低社会经济背景的人。
结论:通过SUS获得药物被证明是打击交叉不平等的工具,相信SUS是促进社会正义的有效公共政策。
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.