Effects of economic recession on elderly patients’ perceptions of access to health care and medicines in Portugal
- 280 Downloads
Background In view of the current financial and demographic situation in Portugal, accessibility to health care may be affected, including the ability to adhere to medication. Objective To evaluate the perceived effects of the crisis on elderly patient’s access to medicines and medical care, and its implications on medicine-taking behaviour. Setting Community pharmacy. Method A cross-sectional study was undertaken during April 2013, where elderly patients answered a self-administered questionnaire based on their health-related experiences in the current and previous year. Binary logistic regression was used to ascertain the effects of potential predictors on the likelihood of adherence. Main outcome measures self-reported adherence. Results A total of 1231 questionnaires were collected. 27.3% of patients had stopped using treatments or health services in the previous year for financial motives; mostly private medical appointments, followed by dentist appointments. Almost 30% of patients stopped purchasing prescribed medicines. Over 20% of patients reduced their use of public services. Out-of-pocket expenses with medicines were considered higher in the current year by 40.1% of patients. The most common strategy developed to cope with increasing costs of medicines was generic substitution, but around 15% of patients also stopped taking their medication or started saving by increasing the interdose interval. Conclusion Reports of decreasing costs with medicines was associated with a decreased likelihood of adherence (OR 0.42; 95% CI 0.27–0.65). Lower perceived health status and having 3 or more co-morbidities were associated with lower odds of adhering, whilst less frequent medical appointments was associated with a higher likelihood of exhibiting adherence.
KeywordsAccess to health care Aged Equity Financial Health care rationing Health policy Medication adherence Portugal
The authors wish to acknowledge Observatório Português dos Sistemas de Saúde (OPSS) for providing the platform for developing this study and the special contributions of other members of the “medicines subgroup”, namely Sérgio Vilão and Fátima Bragança. We also thank all the community pharmacists who actively engaged in patient recruitment and patients who answered the questionnaire.
The study did not receive any specific funding. Printing costs were supported by OPSS and indirect costs were entirely supported by each of the researchers’ organisations.
Conflicts of interest
The authors declare that they have no financial or other relationships that might lead to a conflict of interest.
- 2.Sakellarides C, Castelo-Branco L, Barbosa P, Azevedo H. The impact of the financial crisis on the health system and health in Portugal. European Observatory on Health Systems and Policies. Copenhagen: WHO Regional Office for Europe 2014.Google Scholar
- 9.Quintal C, Lourenço O, Ferreira P. Utilização de cuidados de saúde pela população idosa portuguesa: uma análise por género e classes latentes. Health care utilization of the elderly Portuguese population: an analysis by gender and latent classes. Rev Port Saúde Pública. 2012;30(1):35–46.CrossRefGoogle Scholar
- 11.Dalziel WB. Demographics, aging and health care: Is there a crisis? Can Med Assoc J. 1996;155(11):1584–6.Google Scholar
- 12.Pordata. Ageing Índex in Europe. Source: INE, 2011 and Eurostat 2012. Available at http://www.pordata.pt/en/Europe/Ageing+index-1609. Last Assessed on 10th Aug 2016).
- 13.Portaria no 277/2014, published 26th December (Defines the normal age to have access to ageing pension for the years 2015 and 2016).Google Scholar
- 16.Pordata. “Current expenditure on healthcare as a % of GDP in Portugal”, available at http://www.pordata.pt/en/Portugal/Current+expenditure+on+healthcare+as+a+percentage+of+GDP-610. Last Assessed on the 10th Aug 2016.
- 17.Portaria no 195-D/2015, Diário da República, 1.ª série—No. 125 (Establishes the pharmacotherapeutic groups and subgroups that may be subject to reimbursement and respective copayment strata).Google Scholar
- 18.Teixeira, I, Vieira, I. PPRI Pharma Profile Portugal 2008. Pharmaceutical Pricing and Reimbursement Information; Commissioned by the European Commission, DG SANCO and co-funded by the Austrian Federal Ministry of Health, Family and Youth. October 2008. Available at https://ppri.goeg.at/Downloads/Results/Portugal_PPRI_2008.pdf.
- 19.Dec-Lei 48-A/2010, Diário da República, 1.ª série—No. 93 (Defines the special regimes for reimbursement).Google Scholar
- 21.Portaria no 1320/2010 de 28 de Dezembro, Diário da República, 1.ª série—No. 250 (Defines the “user-fees” to be paid when using different types of health care services).Google Scholar
- 28.Portaria no 137-A/2012. Diário da República, 1.a série—No. 92 (Establishes the rules for prescribing by Common International Denomination).Google Scholar
- 29.European Commission—Directorate General Economic and Financial Affairs. The Economic Adjustment Programme for Portugal. Sixth Review—Autumn 2012. European Economy, Occasional Papers 124; 2012. Available at: http://ec.europa.eu/economy_finance/publications/occasional_paper/2012/pdf/ocp124_en.pdf.
- 30.OECD. Health at a glance 2015: OECD indicators. OECD Publishing, Paris; 2015. doi:http://dx.doi.org/10.1787/health_glance-2015-en.
- 39.Barbui C. Access and use of psychotropic medicines in low-resource settings. Epidemiol Psychiatr Sci. 2015;19:1–4 [Epub ahead of print].Google Scholar