ArticleThe journal of medicine access
Contribution analysis of drug coverage policies on access to medicines for diabetes, dyslipidemia and hypertension in Chile.
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Abstract
Background: Access to medicines remains a persistent global challenge. In Chile, several policies have sought to strengthen pharmaceutical coverage within the health system. Among them, the Explicit Health Guarantees (GES) and the Pharmacy Fund (FOFAR) represent major policy milestones. Objective: This study assesses the impact of GES and FOFAR on access to medicines for diabetes, dyslipidemia, and hypertension among beneficiaries of both public and private subsystems. Design: A contribution analysis approach was applied using a mixed-methods design. Methods: Quantitative analyses combined descriptive and quasi-experimental difference-in-differences methods based on repeated cross-sectional data from national health surveys (2003, 2009/10, 2016/17), focusing on medicine use and effective coverage. The qualitative component included ten semi-structured interviews with key informants involved in policy design and implementation. Results: Results show that both GES and FOFAR substantially contributed to improving access to medicines for hypertension, diabetes, and dyslipidemia. Quantitative findings revealed marked increases in medicine use and effective coverage, particularly between 2010 and 2017, while qualitative evidence highlighted their complementary and reinforcing policy roles. Conclusions: Taken together, our findings suggest that GES and FOFAR were likely important contributors to improvements in contact coverage and effective coverage for these chronic conditions in Chile, although these changes occurred alongside ongoing health-system strengthening efforts and should therefore be interpreted accordingly. Overall, incorporating medicines into social protection schemes-especially through enforceable guarantees-plays a key role in expanding access. Sustained impact requires adequate resources, robust logistics, and strong implementation capacity for chronic disease management.
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