title: Barriers in household access to medicines for chronic conditions in three Latin American countries.
abstract: BACKGROUND
  Access to medicines is one of the major challenges in health policy. The high out-of-pocket expenditures on medicines in the Latin American and Caribbean (LAC) region represents important barrier to affordable access to care for NCDs. This paper aim to identify key barriers in access to medicines for household members with a diagnosed chronic condition in three Central America countries.
  
  
  METHODS
  This was a cross-sectional analytic study, based on data from three household surveys using a common methodology. We examined associated factors to: (1) seeking care for chronic illness from a trained clinician in the formal health system, and (2) obtaining all medicines sought for the chronic conditions reported.
  
  
  RESULTS
  A chronic condition was reported in 29.8 % (827) of 2761 households - 47.0, 30.7 and 11.8 % in Nicaragua, Honduras and Guatemala, respectively. The three main chronic conditions reported were hypertension, arthritis, and diabetes. Seeking care in the formal health system ranged from 73.4 % in Nicaragua to 83.1 % in Honduras, while full access to medicines varied from 71.6 % in Guatemala to 88.0 % in Honduras. The main associated factors of seeking care in the formal health system were geographic location, household head gender, Spanish literacy, patient age, perceived health status, perceived quality of public sector care, household economic level, and having health insurance. Seeking care in the formal health system was the main bivariate associated factor of obtaining full access to medicines (OR: 4.3 95 % CI 2.6 - 7.0). The odds of full access to medicines were significantly higher when the household head was older than 65 years, medicines were obtained for free, households had higher socioeconomic status, and health care was sought in the private sector.
  
  
  CONCLUSIONS
  The nature of the health system plays an important role in access to medicines. Access is better when public facilities are available and function effectively, or when private sector care is affordable. Thus, understanding how people seek care in a given setting and strengthening key health system components will be important strategies to improve access to medicines, especially for populations at high risk of poor access.
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA, 02215, USA. emmerick.isabel@gmail.com.|Center for Pharmaceutical Policies, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, (NAF/ENSP/Fiocruz), Rua Leopoldo Bulhões 1480, Manguinhos, 21041 210, Rio de Janeiro, RJ, Brazil. emmerick.isabel@gmail.com.
authors.forename: Isabel Cristina Martins
authors.initials: IC
authors.lastname: Emmerick
authors.affiliation: Center for Pharmaceutical Policies, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, (NAF/ENSP/Fiocruz), Rua Leopoldo Bulhões 1480, Manguinhos, 21041 210, Rio de Janeiro, RJ, Brazil. negritudesenior@gmail.com.
authors.forename: Vera Lucia
authors.initials: VL
authors.lastname: Luiza
authors.affiliation: Department of Epidemiology and Quantitative Methods in Health, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation (DEMEQS/ENSP/Fiocruz), Rua Leopoldo Bulhões 1480, Manguinhos, 21041 210, Rio de Janeiro, RJ, Brazil. luiz.camacho@ensp.fiocruz.br.
authors.forename: Luiz Antonio Bastos
authors.initials: LA
authors.lastname: Camacho
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA, 02215, USA. Catherine.Vialle@post.harvard.edu.
authors.forename: Catherine
authors.initials: C
authors.lastname: Vialle-Valentin
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA, 02215, USA. Dennis_Ross-Degnan@hms.harvard.edu.
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000191:economics; D003430:Cross-Sectional Studies; D005260:Female; D006166:Guatemala; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006291:Health Policy / Q000191:economics*; D006297:Health Services Accessibility; D006721:Honduras; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009527:Nicaragua