BACKGROUND: Previous research has provided evidence that
socioeconomic status has an impact on invasive treatments use after
acute myocardial infarction. In this paper, we compare the
socioeconomic inequality in the use of high-technology diagnosis and
treatment after acute myocardial infarction between the US, Quebec and
Belgium paying special attention to financial incentives and
regulations as explanatory factors.
METHODS: We examined
hospital-discharge abstracts for all patients older than 65 who were
admitted to hospitals during the 1993-1998 period in the US, Quebec and
Belgium with a primary diagnosis of acute myocardial infarction.
Patients' income data were imputed from the median incomes of their
residential area. For each country, we compared the risk-adjusted
probability of undergoing each procedure between socioeconomic
categories measured by the patient's area median income.
findings indicate that income-related inequality exists in the use of
high-technology treatment and diagnosis techniques that is not
justified by differences in patients' health characteristics. Those
inequalities are largely explained, in the US and Quebec, by
inequalities in distances to hospitals with on-site cardiac facilities.
However, in both Belgium and the US, inequalities persist among
patients admitted to hospitals with on-site cardiac facilities,
rejecting the hospital location effect as the single explanation for
inequalities. Meanwhile, inequality levels diverge across countries
(higher in the US and in Belgium, extremely low in Quebec).
CONCLUSIONS: The findings support the hypothesis that income-related
inequality in treatment for AMI exists and is likely to be affected by
a country's system of health care.