[Social determinants of exclusion from health services and medicines in three Central American countries].
OBJECTIVE
Examine the social determinants that affect population behavior with regard to the search for and acquisition of medicines, and their relationship to exclusion from health services based on aggregate data from three Central American countries: Guatemala, Honduras, and Nicaragua.


METHODS
A descriptive, observational cross-sectional study was conducted by administration of a household survey. The study sample was selected in accordance with the conglomerate method. Data was analyzed with the SPSS® V.17 program using descriptive statistics, bivariate, multivariate, and principal components analysis (PCA).


RESULTS
Although the majority of the persons could access health care, health exclusion (odds ratio [OR] 4.10; 95% confidence interval [95% CI]) was the main determinant of lack of access to medicines. The characteristics of housing (OR 0.747, 95% CI), formal employment of head of the household (OR 0.707, 95% CI), and socioeconomic status of the household (OR 0.462, 95% CI) were also important determinants of lack of access to medicines.


CONCLUSIONS
The phenomena of lack of access to health services and medicines are not independent from one another. It was corroborated that the health system, as an intermediate social determinant of health, is an important factor for improvement of access to medicines. Public policies that aim to achieve universal coverage should consider this relationship in order to be effective.
Sistemas y Servicios de Salud, Organización Panamericana de la Salud, Quito, Ecuador, vera@ensp.fiocruz.br.
Cecilia
C
Acuña
Organización Panamericana de la Salud.
Nelly
N
Marina
Organización Panamericana de la Salud, Bogotá, Colombia.
Adriana
A
Mendoza
Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Isabel Cristina Martins
IC
Emmerick
Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Vera Lucía
VL
Luiza
Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Thiago Botelho
TB
Azeredo
D003430:Cross-Sectional Studies; D005260:Female; D006166:Guatemala; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006721:Honduras; D006801:Humans; D008297:Male; D008875:Middle Aged; D009527:Nicaragua; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires