Análise dos incentivos contratuais do Programa Aqui Tem Farmácia Popular pelo Modelo Principal-Agente

Abstract

Introduction: The Aqui Tem Farmácia Popular program is a significant public policy initiative by the Brazilian federal government aimed at enhancing public access to medications for chronic non-communicable diseases (NCDs). Operated through public-private partnerships with private pharmacies and drugstores, the program offers two subsidy modalities: free access, where users are exempt from co-payment, and co-payment, where users pay the difference between the Ministry of Health's (MS) subsidy and the medication's retail price. The program's success, measured by the number of medications dispensed to the population, hinges on private pharmacies' perceptions of the benefits of participating in the program. Contractual incentives, defined by the program's institutional framework, can influence pharmacies' decisions regarding the number of program beneficiaries served. Objective: This study aims to evaluate the regulatory framework of Aqui Tem Farmácia Popular to identify potential sources of moral hazard. Moral hazard refers to the possibility that the agent (private pharmacies) may act against the interests of the principal (MS), potentially affecting the number of medications dispensed through the public health strategy. Methods: The theoretical analysis of the regulatory framework of the Aqui Tem Farmácia Popular program is conducted using the principal-agent model. This model is applied in situations where the principal (MS) delegates authority to the agent (private pharmacies) to act on its behalf, considering the agent more capable of executing the task. The principal's welfare depends on the agent's actions, occurring in an environment with asymmetric information, as the MS does not directly observe the pharmacies' actions but only evaluates the outcomes, measured by health indicators associated with NCDs. To align interests, an incentive system is designed to motivate agents to act in accordance with the principal's interests and achieve the desired outcomes. Results: Potential sources of moral hazard identified include operational complexity, uncertainty about co-payment values, divergent behaviors of pharmacies based on business models, and misalignment between the prices of medications on the program's list and market prices. These moral hazards stem from behaviors exhibited by pharmacies, users, and the MS. Conclusion: A better-structured contract could mitigate potential sources of moral hazard, thereby enhancing the achievement of program objectives. Recommended actions to reduce moral hazard and increase the number of medications dispensed include providing health benefits education to encourage medication adherence, simplifying product release procedures, monitoring co-payment values paid by users and subsidies provided by the MS per active ingredient, highlighting profit increments for pharmacies through program enrollments, and through the sale of other products available in accredited establishments but not offered through Aqui Tem Farmácia Popular. Analyzing the contract framework results in mutual gains for the MS and participating pharmacies.