Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study

Background: There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development. Methods: We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from −1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated. Findings: The proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0–1·7), Tanzania (0–3·6), and Zimbabwe (0–5·1), to 49·3% in Canada (44·4–54·3). Proportions receiving at least one drug varied from 2·0% (95% CI 0·5–6·9) in Tanzania to 91·4% (86·6–94·6) in Sweden. There was significant (p<0·05) pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines. Interpretation: Use of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications. Funding: Full funding sources listed at the end of the paper (see Acknowledgments)

Technological Change Around The World: Evidence From Heart Attack Care

International audience"Supply side" incentives to curtail health care spending are closely linked with trends in the use of costly treatments. by the Technological Change in Health Care (TECH) Research Network ABSTRACT: Although technological change is a hallmark of health care worldwide , relatively little evidence exists on whether changes in health care differ across the very different health care systems of developed countries. We present new comparative evidence on heart attack care in seventeen countries showing that technological change-changes in medical treatments that affect the quality and cost of care-is universal but has differed greatly around the world. Differences in treatment rates are greatest for costly medical technologies , where strict financing limits and other policies to restrict adoption of intensive technologies have been associated with divergences in medical practices over time. Countries appear to differ systematically in the time at which intensive cardiac procedures began to be widely used and in the rate of growth of the procedures. The differences appear to be related to economic and regulatory incentives of the health care systems and may have important economic and health consequences. H ea lt h c ar e is an i ndu st ry that is becoming part of a global economy. Biomedical knowledge and technologies are already "global" in the sense that leading physicians in all developed countries read the same journals and electronic reviews and participate in international consortia to encourage best practices. For the most part, the same drugs and devices are available worldwide, at least within a few years of each other. Leading clinical researchers and experts collaborate internationally; leading drug and biotechnology firms think globally. As worldwide policy interest in quality of care continues to rise, international comparisons of health care systems are becoming common. Yet health care also remains a local industry, with care delivered by physicians influenced by their local peers, practice settings, and health care policies

The Relationship Between Health Policies, Medical Technology Trends and Outcomes: A Perspective from the TECH Global Research Network

International audienceThe goal of this paper is to present new comparative evidence on heart attack care in 17 countries showing that changes in medical treatments are universal, but have differed greatly. We have collected a large body of comparable information that show how countries differ in treatment rates and why these differences are relatively marked. Countries appear to differ systematically in the time at which intensive cardiac procedures began to be widely used and in the rate of growth of the procedures. Our results show that differences in treatment rates are greatest for expensive medical technologies. Also strict financing limits and regulatory policies have affected the adoption of intensive technologies. These differences may have important economic and health consequences