Comparative analysis of pharmaceutical services models adopted in countries with universal health coverage.

Introduction: Brazil has a universal health system with basic principles of universal and equal access to health actions and services, including Pharmaceutical Services (PS). The entire Brazilian population has the right of access to medicines, selected and standardized through a List of Essential Medicines. Nevertheless, a survey assessed PS at the national level in 2015 and found that there are still major challenges in expanding and ensuring equitable access and service structuring nearly 30 years after the establishment of the Unified Health System (in portuguese Sistema Universal de Saúde - SUS). In this context, understanding and knowing the determining factors for the difficulties still faced by SUS in access to medicines is of fundamental importance, bringing a strategic and comprehensive view of the problem. The objective of this master thesis is to analyze the way PS in Brazil is organized, in perspective with the experiences and results of other countries with Universal Health Coverage (UHC). Methods: The methodology of this work was divided into three complementary parts. First, a review of general aspects of medicines policy in selected countries for knowledge of PS models in countries with UHC. For comparison, an adaptation of the health systems analysis model to medicines policy was performed, with a critical evaluation by experts in the field. Finally, the settings of the adapted method and their results in the selected countries were compared. Results: Information was collected about PS in seven countries: Canada, Australia, Scotland, Sweden, Portugal, South Africa and Colombia. After adaptation and critical evaluation by the experts, the comparison was performed. The parameters compared were: financing, payment, organization, regulation and persuasion. Among them, the biggest difference between the model adopted in Brazil and in other countries was found in the organization. Financing comes mostly through taxes in all countries, although some adopt copayment strategy in a complementary way. Regarding payment, responsibilities are decentralized in the provinces in most countries. The provinces, in turn, hire retail pharmacies to make the general population available. Thus, the acquisition and distribution logistics of medicines end up being the responsibility of the contracted services. In Brazil, however, the responsibilities are partially decentralized in the three federated entities, which purchase and dispensation of the drugs to the population. As for regulation, all countries have an agency for regulating the effectiveness and safety of medicines. In persuasion, strategies to improve the quality of drug use are a reality in the world, although some countries have not formalized them. Conclusion: The comparative analysis of PS showed some possible ways. However, assessing a potential change in public policy is not possible without analyzing its feasibility in the current contexto of the country.

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