[Financial sacrifice and purchasing capacity for medicines in primary care: evidence from a municipality in the Metropolitan Region of Rio de Janeiro, Brazil].

This study analyzed the prevalence and factors associated with financial sacrifice related to access to medicines in primary care users in a municipality in the Metropolitan Region of Rio de Janeiro, Brazil. This cross-sectional study was carried out in 2023 with 290 users of primary care units in Niterói (distributed among Polyclinics, the Family Medical Program, and Psychosocial Care Centers). Financial sacrifice was defined as the need to postpone essential purchases, take out loans, or sell goods to pay for health expenses. Structured questionnaires were applied based on validated methods to evaluate the pharmaceutical sector. Descriptive analyses and binary logistic regression were performed with a 5% significance level. The prevalence of financial sacrifice totaled 35.5% (95%CI: 30.2-41.0), with no significant difference between types of service (p = 0.416). Hospital admission was the only factor independently associated with the outcome (OR = 2.89; 95%CI: 1.05-7.94; p = 0.04). This study found that 6.2% of interviewees reported expenses with medication, with no significant association with financial sacrifice. The most frequent coping strategies referred to bill postponement (14.8%) and formal or informal indebtedness (12.7%), followed by reduction in food purchases (5.2%). Financial sacrifice affects more than a third of primary care users, with hospital admissions being the main associated factor. These findings highlight financial protection gaps in the Brazilian Unified National Health System and reinforce the need to strengthen policies for the public provision of medication and protection against catastrophic expenditures.