Socioeconomic Determinants of Access to Medicines Among Romanian Patients with Chronic Diseases: A Cross-Sectional...

Background and Objectives: Access to medicines is a fundamental determinant of health equity and a core pillar of universal health coverage, encompassing the timely availability, affordability, and appropriate use of essential medicines. Socioeconomic disparities may limit actual and timely access to pharmacological treatment, particularly in healthcare systems characterized by mixed public-private financing and significant out-of-pocket expenditures. This study aimed to evaluate socioeconomic determinants of access to medicines among Romanian patients with chronic diseases, focusing on income level, prescription reimbursement, perceived affordability, and substitution behavior during medicine shortages. Materials and Methods: A cross-sectional study was conducted between October and December 2024 using a structured online questionnaire administered to 200 adult patients diagnosed with cardiovascular diseases, diabetes mellitus, chronic hepatitis B and C, or oncological conditions, recruited at the "Prof. Dr. D. Hociotă" Institute of Phonoaudiology and Functional ENT Surgery, Bucharest, Romania. Associations between income and access-related variables were assessed using Spearman's rank correlation coefficients with 95% confidence intervals. Binary logistic regression identified independent predictors of perceived difficulty in accessing medicines (p < 0.05). Results: Lower income was significantly associated with greater reliance on reimbursed prescriptions (r_s = -0.241, 95% CI: -0.37 to -0.10, p = 0.001) and fully reimbursed prescriptions (r_s = -0.305, 95% CI: -0.43 to -0.17, p < 0.001). Income was strongly correlated with perceived affordability of treatment (r_s = 0.601, 95% CI: 0.50-0.69, p < 0.001). In multivariate logistic regression analysis, income below 3000 RON/month (adjusted OR = 1.94, 95% CI: 1.05-3.58, p = 0.034) and insufficient affordability (adjusted OR = 4.12, 95% CI: 2.15-7.89, p < 0.001) were independently associated with perceived difficult access to treatment. Additionally, 80% of respondents reported purchasing substitute medicines when prescribed medicines were unavailable. Conclusions: This cross-sectional study indicates that socioeconomic status and perceived affordability are significant determinants of access to medicines among Romanian patients with chronic diseases attending a tertiary ENT centre. Financial vulnerability remains a major barrier despite existing reimbursement mechanisms. Policy interventions aimed at strengthening income-sensitive reimbursement strategies and ensuring consistent pharmaceutical availability may improve equitable access and therapeutic continuity.