Evaluation equity in access to medicines using concentration curve in Republic of Moldova

Abstract

Introduction. Equitable access to medicines is one of the essential challenges in developing and transitional countries. It is stated that about one-third of the populations around the world do not have equitable access to essential medicines. The prices are often unaffordable for majority of population. This has made medicines the second largest family expenditure after food and has made the cost of the medicines unaffordable for a huge number of people. Up to 50% of medicines are inappropriately prescribed or dispensed and up to 50% are used incorrectly by patients. This leads to significant wasted resources, the potential to drive the development of drug resistance and to poor health outcomes. Many patients, especially the poor, rely on the informal sector for their health care needs including medicines, while respective vendors have little or no pharmacy training. Aim of the study. Assessment the equity in access to medicines in Republic of Moldova through health system perspective. Materials and methods. Have been conducted a descriptive cross-sectional study of international practice on strengthen policy framework on equitable access to medicines; secondly has been done a quantitative study using concentration curve on the population of Republic of Moldova regarding the access to medicines. Results. Equity is one of the fundamental principles and right of people in the healthcare system worldwide. According to World Health Organization, equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically. Health inequities therefore involve more than inequality with respect to health determinants, access to the resources needed to improve and maintain health or health outcomes. From the previous authors study have been disclose the following access indicators and barriers to medicines with different access incentives (AI): geographical accessibility (8-AI), affordability (7-AI), availability of medicines (8-AI) and acceptability (2-AI). The two key variables underlying the concentration curve are the access to medicines variable, the distribution of which is the subject of interest, and a variable capturing living standard against which the distribution is to be assessed. The health variable must be measured in units that can be aggregated across individuals. This is not necessary for the living standards measure, which is used only to rank individuals from richest to poorest. First step in concentration curve analysis is to score the indicators of access based on discomfort and annoyance caused by unavailability of medicines. The higher scores of indicators determine the power of influence on access to medicines. These results will be correlated with the following factors: demographic, age, gender; socioeconomic factors: ethnicity (Caucasian and non-Caucasian), housing condition, level of education, income (monthly family income per head), classified per quintiles. Conclusions. The present study provides insights into the socioeconomic factors associated with access to medicines in Republic of Moldova. Knowledge about inequalities in access to medication is important for health policies to contribute to reducing inequalities in health care services use and will be investigated more deeply.