Free healthcare levels AMI inequalities for low-income earners
MedWire News: Free universal medical coverage does not appear to be enough to guarantee optimal adherence to secondary-prevention medications, research shows.
However, the study showed that providing full medical coverage for low-income earners leveled inequalities in the treatment of acute myocardial infarction (AMI).
"Providing access to optimal care for socially deprived patients is of particular importance because their health hazards are greater," state Nicolas Danchin (Université René Descartes, Paris, France) and colleagues.
Published in the journal Circulation: Cardiovascular Quality and Outcomes, the researchers used the reimbursement database in France to determine the impact of full medical coverage for low income earners, aged less than 60 years, on treatment and outcomes of patients with AMI.
Among 4939 patients hospitalized for AMI over a 6-month period in 2006, 12% of patients had free medical coverage from the Couverture Médicale Universelle Complémentaire (CMUC).
Overall, CMUC patients were admitted to the same hospitals, including academic medical institutions, as non-CMUC patients, and were equally likely to receive coronary catheterization and coronary interventions.
In-hospital mortality was also comparable between the two groups (3.1% in the CMUC patients vs 2.8% in the non-CMUC group; p=0.69).
Secondary prevention medications, including aspirin, clopidogrel, statins, angiotensin-converting enzyme inhibitors, and beta-blockers, were used less frequently in CMUC than non-CMUC patients, but the difference in absolute terms was "small." After multivariate adjustment, the difference in medication use was not statistically significant.
However, beyond 6 months, just 64% of patients in the CMUC group were adhering to statin therapy, a rate that was significantly lower than the 77% in the non-CMUC group (p<0.001), report the investigators.
There was also a trend toward lower survival (hazard ratio [HR]=1.18) and freedom from acute coronary syndromes (HR 1.21) in the CMUC group at 30 months.
These data suggest that free universal medical coverage is "not sufficient to ensure optimal long-term medical care," say Danchin and colleagues, "despite the fact that the medications could be delivered at no cost."
Patient education efforts, particularly among low-income earners, are still needed, they add.
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