Impact of Free Universal Medical Coverage on Medical Care and Outcomes in Low-Income Patients Hospitalized for Acute Myocardial Infarction

Abstract

Background-The type of medical coverage in patients with acute myocardial infarction (AMI) may affect their treatment and outcome. Methods and Results-We used the reimbursement database from the French National Health Insurance to determine the impact of full medical coverage (Couverture Médicale Universelle Complémentaire, CMUC), a free supplemental insurance for low-income earners Ͻ60 years of age, on treatment and outcomes of patients with AMI. The population comprised consecutive patients Ͻ60 years of age hospitalized for AMI from January to June 2006 in France. Of 4939 patients with AMI aged Ͻ60 years, 587 (12%) were on the CMUC. CMUC patients were younger, with more prior cardiovascular and comorbid conditions. CMUC and non-CMUC patients were admitted to the same types of institutions, including academic hospitals and private clinics. The use of cardiac catheterization and coronary interventions was similar (adjusted relative risk, 0.97; 95% confidence interval, 0.91-1.05; Pϭ0.45). In-hospital mortality was also comparable (3.1% versus 2.8%, Pϭ0.69). There was no difference in early use of secondary prevention medications after multivariate adjustment. At 30 months, survival and acute coronary syndrome-free survival were lower in CMUC patients (trend, not significant after adjustment). Long-term adherence to statin therapy was lower in CMUC patients (64% versus 77%; adjusted relative risk, 0.82; 95% confidence interval, 0.73-0.92). Conclusions-Free full coverage for socially deprived people levels inequalities in the acute and midterm treatment of AMI patients. However, full reimbursement per se is not sufficient to ensure optimal patient adherence to secondary prevention medications and may not be enough to prevent an excess of long-term events. (Circ Cardiovasc Qual Outcomes. 2011;4:619-625.)

Patient education after acute myocardial infarction

“…As insurance coverage in France is universal, the finding that patients in upper socioeconomic classes called earlier is likely to reflect better information and greater health consciousness than that seen in patients with a lower socioeconomic status. 17 Education after acute myocardial infarction In our study, history of IHD was not associated with shorter TOFC. These results are surprising because a shorter time delay would be expected in patients with a history of IHD (especially in patients with previous AMI) because either they had personally experienced a previous AMI, or their general practitioners or cardiologists would have been expected to have educated them so that they would recognize the symptoms of AMI.…”

Adherence to evidence-based secondary prevention pharmacotherapy in patients after an acute coronary syndrome: A systematic review

“…Medication adherence at 1-year follow-up was higher in countries where universal health coverage existed. Risk factors associated with non-adherence were examined in a 24,26,27,29,30,33,35,37,38 limited number of studies, and the results varied across the medication classes assessed. Our findings of suboptimal medication adherence are similar to the results of a prior systematic review showing that about one third of patients with CHD did not adhere to effective cardiac medications after a median follow-up of 24 months.…”

“…Overall, 14 studies 23e27,29e35,37,38 used claims-based data to estimate medication adherence. The remaining 2 studies used data from telephone surveys 28 Nine studies 23,24,26,30,31,33,34,36,37 provided information about the average age of their study sample, which ranged from 50 to 80 years. The majority of participants in our included studies was white, though only 3 US-based studies 25,33,36 provided data on race/ ethnicity.…”

“…The majority of participants in our included studies was white, though only 3 US-based studies 25,33,36 provided data on race/ ethnicity. Overall, 6 studies 23,26,29,31,36,37 examined the use of a single cardiac medication, while the other 10 studies 24,25,27,28,30,32e35,38 examined adherence to multiple cardiac drugs. The most common measures used for assessing medication adherence were proportion of days covered (PDC) (n ¼ 9), 24,26,27,29,30,33,35,37,38 followed by medication possession ratio (MPR) (n ¼ 5), 23,25,31,32,34 electronic medication monitors (n ¼ 1), 36 and self-reported data (n ¼ 1).…”

Impact of Socioeconomic Status on In-Hospital Outcome of Patients with Acute Coronary Syndrome in Egypt

“…But few studies mentioned important association between SES and IHD mortality [25] and others mentioned no or weak associations [26].…”