Access to medicines for the treatment of chronic diseases in Chile: qualitative analysis of perceived patient barriers and facilitators in five regions of the country

Purpose To know patients’ perceptions of barriers and facilitators in access to medicines in general, and those associated with the treatment of three chronic conditions of high prevalence in Chile: diabetes, dyslipidemia and hypertension. Methods: Ten focus groups of patients with these diseases, diagnosed for at least six months and prescribed medication, were included. These were carried out in five regions of Chile: Arica, in the north, Aysén, in the south, and Valparaíso, Metropolitan, and Maule, in the central zone. The criteria for the formation of groups were region, age, health system (public or private) and socioeconomic level (residence commune). Sessions were recorded, transcribed, and analyzed by categories. Results The experience of access to medicines is determined by the insurance system, the experience of care with public or private providers, and geographical-administrative difference between capital and other regions. Beneficiaries of public sector, despite their greater socioeconomic vulnerability, perceive greater protection in access: access conditions, delivery reliability and adherence to pharmacological treatment are met. The main problem observed is the financing of treatments not covered by the health system. Policyholders in private sector perceive that they have access to medicines of better quality than those provided free of charge by public sector, but raise fears associated with the inability to afford them and distrust in the process, linked to alliances between laboratories and physicians. Public sector beneficiaries value territorial coverage of primary care, which guarantees access in isolated areas. Regarding the type of provider, public sector shows greater capacity for user loyalty, which is expressed in regular visits and follow-up; unlike discontinuous examinations among private sector beneficiaries. Conclusions Different access conditions both at the territorial level and in the health subsystems are evident. It is necessary to make progress in addressing the problem of access to medicines in a comprehensive manner. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Funding: FONIS SA19|0174 Project, granted by the National Agency for Research and Development, Chile (ANID). https://www.anid.cl/ Funding was provided to Universidad del Desarrollo, not directly to the investigators. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study is part of the FONIS Project SA19|0174, which was approved by the Bioethics Committee of the Faculty of Medicine of Clínica Alemana, Universidad del Desarrollo (approval 2019-020). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Once accepted, transcripts from the focus groups will be uploaded to a public repository and the URL will be shared with PLOS ONE. Transcripts are in Spanish only.