Equity analysis of resource distribution for the Popular Pharmacy Program.

OBJECTIVE: To analyze the regional allocation of the resources from the Brazilian Popular Pharmacy Program, taking into account the relative availability of the program and the potential needs of the region. METHODS: Data from the National Health Survey of the Annual Report of Social Information and the administrative database of the program were used to create a non-parametric indicator of coverage using multiple data envelopment analysis technique. This indicator considers the relative availability of the program, taking into account equal access to equal needs (equity based on regional needs). The analysis of this indicator shows if the regions that most need pharmaceutical assistance are those that receive more resources from the Brazilian Popular Pharmacy Program. RESULTS: The states belonging to the richest regions of the country, Southeast and South, present wider relative coverage of the Brazilian Popular Pharmacy Program compared to poorer localities. In addition, the inequalities observed between locations are better explained by inefficiency in the transfer of resources to the basic component of pharmaceutical care than by the Brazilian Popular Pharmacy Program itself. According to the model, a 43.76% increase in the transfer to the basic component of pharmaceutical care would be required in order to improve equity, whereas the increase required by the Brazilian Popular Pharmacy Program is equivalent to 22.71%. CONCLUSIONS: Although the Brazilian Popular Pharmacy Program seeks to reduce the socioeconomic inequalities observed in access to pharmaceutical care, which integrates health care services, regional disparities in access to medicine persist. These regional differences are attributed mostly to allocation failures and problems in managing the conventional pharmaceutical care cycle provided through SUS pharmacies.

Equity analysis of resource distribution for the Popular Pharmacy Program / Análise de equidade da distribuição de recursos do Programa Farmácia Popular

ABSTRACT OBJECTIVE To analyze the regional allocation of the resources from the Brazilian Popular Pharmacy Program, taking into account the relative availability of the program and the potential needs of the region. METHODS Data from the National Health Survey of the Annual Report of Social Information and the administrative database of the program were used to create a non-parametric indicator of coverage using multiple data envelopment analysis technique. This indicator considers the relative availability of the program, taking into account equal access to equal needs (equity based on regional needs). The analysis of this indicator shows if the regions that most need pharmaceutical assistance are those that receive more resources from the Brazilian Popular Pharmacy Program. RESULTS The states belonging to the richest regions of the country, Southeast and South, present wider relative coverage of the Brazilian Popular Pharmacy Program compared to poorer localities. In addition, the inequalities observed between locations are better explained by inefficiency in the transfer of resources to the basic component of pharmaceutical care than by the Brazilian Popular Pharmacy Program itself. According to the model, a 43.76% increase in the transfer to the basic component of pharmaceutical care would be required in order to improve equity, whereas the increase required by the Brazilian Popular Pharmacy Program is equivalent to 22.71%. CONCLUSIONS Although the Brazilian Popular Pharmacy Program seeks to reduce the socioeconomic inequalities observed in access to pharmaceutical care, which integrates health care services, regional disparities in access to medicine persist. These regional differences are attributed mostly to allocation failures and problems in managing the conventional pharmaceutical care cycle provided through SUS pharmacies.

RESUMO OBJETIVO Analisar a alocação regional dos recursos do Programa Farmácia Popular do Brasil, levando em conta a disponibilidade relativa do programa e as necessidades potenciais da região. MÉTODOS Os dados da Pesquisa Nacional de Saúde, da Relação Anual de Informações Sociais e da base administrativa do programa foram usados para criar um indicador não paramétrico de cobertura a partir da técnica de análise envoltória de dados múltipla. Esse indicador considera a disponibilidade relativa do programa, considerando a equidade de acesso para necessidades idênticas (equidade baseada nas necessidades regionais). A análise desse indicador mostra se as regiões que mais necessitam de assistência farmacêutica são aquelas que recebem mais recursos do Programa Farmácia Popular do Brasil. RESULTADOS Os estados pertencentes às regiões mais ricas do país, Sudeste e Sul, apresentam maior cobertura relativa do Programa Farmácia Popular do Brasil em relação às localidades mais pobres. Ademais, as desigualdades observadas entre os locais são melhor explicadas por ineficiência no repasse dos recursos para o componente básico da assistência farmacêutica do que pelo Programa Farmácia Popular do Brasil em si. Segundo o modelo, para melhorar a equidade, seria necessário um aumento de 43,76% nos repasses ao componente básico da assistência farmacêutica, enquanto o aumento requerido pelo Programa Farmácia Popular do Brasil equivale a 22,71%. CONCLUSÕES Apesar de o Programa Farmácia Popular do Brasil buscar atenuar as desigualdades socioeconômicas observadas no acesso à assistência farmacêutica, que integra os serviços de atenção à saúde, persistem as disparidades regionais no acesso a medicamentos. Essas diferenças regionais são atribuídas em maior parte a falhas na alocação e problemas na gestão do ciclo de assistência farmacêutica convencional prestada por meio das farmácias do SUS.

Demanda por bebidas alcoólicas e cigarros no Brasil: elasticidades, microssimulação e variações no bem-estar / Demand for alcohol and cigarettes in Brazil : elasticities, microsimulation and welfare change

Este artigo analisa a demanda das famílias brasileiras por bebidas alcoólicas e cigarros, com ênfase nas elasticidades (preço, despesa restrita e renda) e nas simulações de mudanças nos preços destes itens sobre o bem-estar dos consumidores. A abordagem Quadratic Almost Ideal Demand System ajustada para consumo censurado e endogeneidade das despesas em conjunto com os dados da Pesquisa de Orçamentos Familiares 2008-2009 e do Suplemento de Tabagismo da Pesquisa Nacional por Amostra de Domicílios 2008 compõem a estratégia empírica deste estudo. Os resultados centrais mostram que cigarro e bebidas alcoólicas possuem positivas elasticidades dispêndio e renda e relação de substitutibilidade, independentemente do nível de renda familiar per capita e da macrorregião de residência. Choques positivos nos preços desses itens possuem um baixo ajustamento de demanda, assim como a taxa de compensação monetária requerida em função de mudanças nos preços do cigarro ou da bebida alcoólica apresentam comportamentos distintos com o nível de renda familiar e das regiões de residência. Pela medida de variação compensatória, famílias com maiores níveis de renda são mais resistentes a reduzir o consumo de bebidas, enquanto que para o cigarro o nível de resistência é maior para as famílias mais pobres.

This paper analyzes the demand of Brazilian families for alcoholic beverages and cigarettes, with emphasis on elasticities (price, restricted expenditure and income) and simulations of changes in the prices of these items on the welfare. We use the Quadratic Almost Ideal Demand System adjusted for censored consumption and expenditure endogeneity together with data from the Household Budget Survey 2008-2009 and the Smoking Supplement of the National Research by Household Sample 2008. The main results show that cigarettes and alcohol have positive expenditure and income elasticities of demand and substitution relationship in terms of cross-price, regardless of per capita income level and region of residence. Positive price changes in these items have low adjustment of demand, as well as the rate of monetary compensation required due to changes in cigarette or alcohol have different trends to the level of family income and residence areas. The measure of compensating variation shows that families with higher income levels are more resistant to reduce the consumption of beverages, while for the cigarette the level of resistance is higher for the poorest families.