Medicine access and pharmaceutical services evaluation in Brazilian health care system: A review

Since the 70’s the Brazilian government has been developing actions for improving medicine access. According to official data, the medicine expenses have been remarkably growing in recent years and this is putting increasing pressure on health care budgets. Here it was reviewed whether and, if so, how these funding has been evaluated and which results it produces on public health.  Scielo, Lilacs  and the Ministry of Education’s bases of theses were used as data bases. The search was done with key word “pharmaceutical assistance”, the common term used in Brazil to refer the services and the policies about medicine supply. The publications were selected according to their main objective: analysis, description of the performance or evaluations and evaluation methodology development. Most of publications were from and for academia showing the Brazilian lack of tradition in follow services and policies with evaluation practices. It was observed a kind of “decade pattern” in the publications. In the 80’s, just after 20 years of military dictatorship and just before the creation of the National Health Care System, and perhaps as a reaction to the weak role of the state in supplying medicines, the publications were mostly concerned with the performance of the private sector, as the pharmacist absence and the predominance of commercial practices in pharmacies. It was also found studies on prescription patterns accordingly with WHO methodology. In the 90’s, the most worthwhile publications strengthening the need of a national medicine policy. In the current decade there are an increasing number of publications from postgraduate education showing greater concern of academia in this subject. They are mainly descriptions of performance and/or evaluations, mostly based in Donabedian approach, albeit focused more in medicines logistic than pharmaceutical procedures or results. No systematic evaluation is being running despite the increasing expenses of the Brazilian government.