Impact of Universal Health Insurance Coverage on Hypertension Management: A Cross-National Study in the United States and England

Article


Scuteri, Angelo, Dalton, Andrew R. H., Vamos, Eszter P., Harris, Matthew J., Netuveli, G., Wachter, Robert M., Majeed, Azeem and Millett, Christopher 2014. Impact of Universal Health Insurance Coverage on Hypertension Management: A Cross-National Study in the United States and England. PLOS ONE. 9 (1), p. e83705.
AuthorsScuteri, Angelo, Dalton, Andrew R. H., Vamos, Eszter P., Harris, Matthew J., Netuveli, G., Wachter, Robert M., Majeed, Azeem and Millett, Christopher
Abstract

Background: The Patient Protection and Affordable Care Act (ACA) galvanised debate in the United States (US) over
universal health coverage. Comparison with countries providing universal coverage may illustrate whether the ACA can
improve health outcomes and reduce disparities. We aimed to compare quality and disparities in hypertension
management by socio-economic position in the US and England, the latter of which has universal health care.
Method: We used data from the Health and Retirement Survey in the US, and the English Longitudinal Study for Aging from
England, including non-Hispanic White respondents aged 50–64 years (US market-based v NHS) and .65 years (USMedicare
v NHS) with diagnosed hypertension. We compared blood pressure control to clinical guideline (140/90 mmHg)
and audit (150/90 mmHg) targets; mean systolic and diastolic blood pressure and antihypertensive prescribing, and
disparities in each by educational attainment, income and wealth, using regression models.
Results: There were no significant differences in aggregate achievement of clinical targets aged 50 to 65 years (US marketbased
vs. NHS- 62.3% vs. 61.3% [p = 0.835]). There was, however, greater control in the US in patients aged 65 years and over
(US Medicare vs. NHS- 53.5% vs. 58.2% [p = 0.043]). England had no significant socioeconomic disparity in blood pressure
control (60.9% vs. 63.5% [p = 0.588], high and low wealth aged $65 years). The US had socioeconomic differences in the 50–
64 years group (71.7% vs. 55.2% [p = 0.003], high and low wealth); these were attenuated but not abolished in Medicare
beneficiaries.
Conclusion: Moves towards universal health coverage in the US may reduce disparities in hypertension management. The
current situation, providing universal coverage for residents aged 65 years and over, may not be sufficient for equality in
care.

JournalPLOS ONE
Journal citation9 (1), p. e83705
ISSN1932-6203
Year2014
PublisherPublic Library of Science
Accepted author manuscript
License
CC BY
Web address (URL)http://dx.doi.org/10.1371/journal.pone.0083705
Publication dates
Print08 Jan 2014
Publication process dates
Deposited10 Sep 2015
Accepted06 Nov 2013
FunderEconomic and Social Research Council
Copyright information© 2014 Dalton, et.al.
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