Ethnic Disparities in Out-of-pocket Expense on Medicines in Peru: Evidence From a Nationwide Survey.

Abstract

Background: We aimed to analyze the ethnic disparities in the out-of-pocket (OOP) payment and estimate the gaps related to observable risk factors in the OOP payment on medicines by ethnic conditions during 2014-2016 in Peru. Methods: We conducted a cross-sectional analytical secondary data analysis using the National Health User Satisfaction Survey. The outcome was the OOP payment in self-reported medications by participants. The ethnic condition was considered using the language participants habitually spoke at home (Spanish, Quechua/other). We collected confounding variables: sex, age, education, health insurance, medical prescription and region of residence. Crude and adjusted regression models were performed to assess the gaps in OPP payment on medications among ethnic conditions. The association measure was the Beta coefficient (β) with 95% confidence intervals (95%CI). The Oaxaca-Blinder decomposition method assessed the OPP payment differential in the two study groups explained by their individual and sociodemographic characteristics. Results: We analyzed 11,346 surveyed, the mean age was 40.78 years, and 57.67% were women. In the adjusted analysis, there was lower OOP payment in medications in participants speaking Quechua or other languages than those who speak Spanish (β: -0.11; 95%CI: -0.21 to -0.01; p=0.043). In the Oaxaca-Blinder decomposition analysis, a gap of 0.19 USD in the OOP payment in medicines was found, which disadvantages those minority ethnic conditions (p<0.001), and the explained component represents 41.2% of the gap (p<0.05). Conclusion: There were fewer out-of-pocket payments on medicines for ethnic minorities, and the observable differences explain approximately 40% of these gaps.