Impact of universal coverage on hypertension management: a cross-national study in the United States and England
Author(s)
Type
Journal Article
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.
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.
Date Issued
2014-01-08
Date Acceptance
2013-11-06
Citation
PLoS ONE, 2014, (submitted), 9 (1)
ISSN
1932-6203
Publisher
Public Library of Science (PLoS)
Journal / Book Title
PLoS ONE
Volume
9
Issue
1
Copyright Statement
© 2014 Dalton et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited (https://creativecommons.org/licenses/by/4.0/).
License URL
Subjects
Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
HIGH BLOOD-PRESSURE
PRIMARY-CARE
POPULATION HEALTH
US ADULTS
DISEASE
DISADVANTAGE
MORTALITY
HEART
Antihypertensive Agents
Blood Pressure
England
Humans
Hypertension
Insurance, Health
Middle Aged
Risk Factors
United States
Universal Coverage
MD Multidisciplinary
General Science & Technology
Edition
(submitted)
Publication Status
Submitted