Abstract
BackgroundUniversal health-care coverage has attracted the interest of policy makers as a way of achieving health equity. However, previous reports have shown that despite universal coverage, socioeconomic disparity persists in access to high-tech invasive care, such as cardiac treatment. In this study, we aimed to investigate the association between socioeconomic status and care of aortic stenosis in the context of Japan's health-care system, which is mainly publicly funded.MethodsWe chose aortic stenosis in older people as a target because such patients are likely to be affected by socioeconomic disparity. Using a large Japanese claim-based inpatient database, we identified 12,893 isolated aortic stenosis patients aged over 65 years who were hospitalized between July 2010 and March 2012. Municipality socioeconomic status was represented by the mean household income of the patients' residential municipality, categorized into quartiles. The likelihood of undergoing aortic valve surgery and in-hospital mortality was regressed against socioeconomic status level with adjustments for hospital volume, regional number of cardiac surgeons per 1 million population, and patients' clinical status.ResultsWe found no significant differences between the highest and lowest quartile groups in surgical indication (odds ratio, 0.84; 95% confidence interval, 0.69–1.03) or in-hospital mortality (1.00; 0.68–1.48). Hospital volume was significantly associated with lower postoperative mortality (odds ratio of the highest volume tertile to the lowest, 0.49; 0.34–0.71).ConclusionsUnder Japan's current universal health-care coverage, municipality socioeconomic status did not appear to have a systematic relationship with either treatment decision for surgical intervention or postoperative survival following aortic valve surgery among older patients. Our results imply that universal health-care coverage with high publicly funded coverage offers equal access to high-tech cardiovascular care.
Highlights
Equal access to health care is a major policy concern for achieving health equity in different countries
Investigations in Canada [3,4], Australia [5], and Taiwan [6], where Universal health coverage (UHC) has been in effect for decades, have indicated a persisting access gap to high-quality medical care, such as cardiac interventions, which suggests the need for further action to achieve access equity under UHC
The ‘‘World Health Report 2010’’ of the World Health Organization [7] proposed that to achieve equal access to health care, UHC needs to strike a balance in the proportion of the population covered, the range of available services, and the proportion of direct costs covered by public funding
Summary
Equal access to health care is a major policy concern for achieving health equity in different countries. According to the latest health statistics from the Organisation for Economic Co-operation and Development (OECD) and other data sources, the proportion of health-care spending covered by public funding in those places was lower (Canada, 66.4% in 2010 [8]; Australia, 64.4% in 2010 [8]; Taiwan, 53% in 2005 [9]) than in other OECD countries, such as Japan (81.4%) [8] Given this background, we hypothesized that high coverage by public funding would make a difference in the level of equal access to high-tech invasive care under a UHC scheme. We aimed to investigate the association between socioeconomic status and care of aortic stenosis in the context of Japan’s health-care system, which is mainly publicly funded
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