Access to medicines for the treatment of chronic diseases in Chile: qualitative analysis of perceived patient barriers and facilitators in five regions of the country

Abstract

AbstractPurposeTo know patients’ perceptions of barriers and facilitators in access to medicines in general, and those associated with the treatment of three chronic conditions of high prevalence in Chile: diabetes, dyslipidemia and hypertension. Methods: Ten focus groups of patients with these diseases, diagnosed for at least six months and prescribed medication, were included. These were carried out in five regions of Chile: Arica, in the north, Aysén, in the south, and Valparaíso, Metropolitan, and Maule, in the central zone. The criteria for the formation of groups were region, age, health system (public or private) and socioeconomic level (residence commune). Sessions were recorded, transcribed, and analyzed by categories.ResultsThe 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, despite their greater socioeconomic vulnerability, perceive greater protection in access: access conditions, delivery reliability and adherence to pharmacological treatment are met. The main problem observed is the financing of treatments not covered by the health system. Policyholders in 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 process, linked to alliances between laboratories and physicians. Public sector beneficiaries value territorial coverage of primary care, which guarantees access in isolated areas. 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.ConclusionsDifferent 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.