Individual and contextual determinants of out-of-pocket expenditure on medicines in primary care

Tatiana Luz, Jéssica Alves, Liliany Carvalho, Maria Angelica Bueno, Leila Passagli

Research output: Contribution to conferenceSpeechpeer-review


BACKGROUND: The Brazilian National Healthcare System is one of the largest in the world that aims to provide free access to medicines. Although advances have occurred, it is still not possible to overcome the risk of impoverishment due to out-of-pocket (OOP) expenditure on medicines. This study aims to estimate the prevalence and determinants of OOP among primary care users in Brazil.

METHODS: We administered, in 2017, exit surveys to a representative sample of users (n=1221) from pharmaceutical services in primary care in a health pole municipality (234,937 inhab.) from the midwest macrorregion in Minas Gerais State, Brazil. We assessed the prevalence and examined the role of social and demographic factors, health conditions, health system characteristics and contextual factors on OOP. Descriptive statistics and logistic regression analysis were applied.

RESULTS: The prevalence of OOP was 76.5%. OOP showed significantly relationship with poor perception of health (OR=1.90; 95%CI: 1.65-2.19), multiple comorbidities (2+, OR=2.82; 95%CI: 2.07-3.83), private health insurance coverage (OR=1.41; 95%CI: 1.07-1.89), older age (50+, OR = 1,83; 95%CI: 1,35-2,49), polypharmacy (4+, OR=3,09; 95%CI: 2,28-4,18), high personal income (OR=1,55; 95% CI: 1,11-2,15). Furthermore, perceptions of neighborhood safety and generalized trust showed higher odds of OOP (OR = 1.35, 95%CI 1.01-1.80; OR = 1.39, 95%CI 1.06-1.81, respectively).

CONCLUSION: This is the first study in Brazil that analyzed individual and contextual factors associated with OOP. The high prevalence of OOP suggests that there is an unfinished public agenda for attaining universal medicines coverage.
Original languageEnglish
Publication statusPublished - 7 Mar 2020
EventEuroDURG 2020 - Szeged, Hungary
Duration: 3 Mar 20207 Mar 2020


ConferenceEuroDURG 2020


  • medicines
  • out of pocket expenses
  • primary care users
  • Brazil


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