摘要：Objectives. We sought to investigate, across different socioeconomic groups, the proportion of household medicine expenses that were paid by households and the proportion paid by the Brazilian national health system. Methods. We carried out a survey in Porto Alegre, Brazil, that included 2988 individuals of all ages. We defined 2 expenditure variables: “out-of-pocket medicines value” (the sum of retail prices of all medicines used by family members within the previous 15 days and paid for out of pocket) and “free medicines value” (a similar definition for medicines obtained without charge). Results. In 2003, the Brazilian national health system provided, free of charge, 78% of the monetary value of medicines reported (79% in the bottom wealth quintile and 32% in the top 2 quintiles). The mean out-of-pocket expense for medicines was 6 times greater among the top wealth quintiles compared with those in lower quintiles, but free medicines constituted a 3-times-greater proportion of potential expenditures for medicines among the bottom quintile than among the top 2 quintiles. Conclusions. Free provision of medicines seems to be saving substantial amounts of medicine expenditures for poor people in Brazil. Increasing health care expenditures are a worldwide concern. 1 These increases are associated with several factors, including aging populations, demographic and epidemiological transitions, and new expensive medicines and technology. 2 Medicine expenses contribute significantly to health care expenditures and have been increasing at an even faster rate. In Canada, per capita annual medicine expenses rose more than 4-fold from 1985 to 2004. 3 In Portugal, the percentage of medicine costs in relation to overall health care expenses doubled from 1980 to 1998. 4 Health care expenses are also of significant concern in Brazil. Health care is the fourth largest category of household expenditures, after housing, food, and transportation expenses. 5 , 6 Among all health care expenses, medicines account for the largest share, particularly among the poorest members of the population. 5 – 8 According to national household surveys in Brazil, medicines represented 37% of health care expenses in 1995 to 1996 5 and 41% in 2002 to 2003. 6 Medicines accounted for 20% of health care expenses among families who belonged to the bottom wealth quintile. 1 From national data, it has been shown that the wealthiest families (15% of total) in Brazil consumed 3 times more medicines than did the poorest families (50% of total). 9 The Brazilian national universal and integral health system ( Sistema Único de Saúde , or SUS) is committed to supporting access to medicines. The Brazilian Ministry of Health spent US $618 million on medicines in 2003, and this expenditure increased to US $2.9 billion in 2006. 10 Half of all medicines used by the population are obtained free of charge from the SUS. 11 The Family Health Program ( Programa Saúde da Família , or PSF) is a primary health care strategy launched by the SUS in 1994. The founding principles of PSF are to work at the family level, to offer both curative and preventive care, and to actively seek those in need of attention through a multiprofessional team formed by a doctor, nurses, and community health agents. To date, information is lacking about household spending on health care and medicines, especially on who is getting free medicines supplied by the SUS and how much less households spend because the SUS provides free medicines. Existing data from national population surveys do not provide information on types of medicines used, on indication (professional-prescribed vs self-medication) or on frequency, 5 – 7 or only represent specific population subgroups. 12 We aimed to investigate, across different socioeconomic groups, how much all households spent on medicines and how much value in the form of free medicines the SUS supplied free of charge to families. These 2 variables were analyzed both as absolute values and as proportions of household income and of total health care expenses.
