Health insurance coverage is the single most prominent socioeconomic factor associated with cardiovascular drug delivery in the French population.
OBJECTIVE
Although the French population benefits from universal health coverage, prescribed drugs are in most cases only partially reimbursed by the national insurance plan (65% of the cost), raising the possibility of reduced drug access for patients with low socioeconomic status.


METHODS
To explore this question, the delivery of cardiovascular drugs in relation to socioeconomic position was analysed in a cross-sectional survey of a nationally representative sample of patients with cardiovascular condition (n = 4646).


RESULTS
Among eight socioeconomic indicators and after adjustment for healthcare needs, only health coverage is independently associated with cardiovascular drug delivery, which is reduced by half [odds ratio (95% confidence interval): 0.54 (0.39-0.74), P = 0.0001] in patients partially covered by universal health insurance compared with those fully covered by supplemental insurance. This reduced delivery in patients with partial health coverage seems to apply to all cardiovascular drug classes as it is observed for both antihypertensive and hypolipemic drugs when these classes are tested separately. Although physician access is also reduced in patients with partial health coverage [0.54 (0.40-0.75), P = 0.0002], this does not explain the decreased delivery of cardiovascular drugs that is still observed [0.59 (0.43-0.82), P = 0.001] after further adjustment for the number of physician visits during the survey.


CONCLUSIONS
These results suggest that health insurance coverage has a prominent role among socioeconomic factors in determining the delivery of prescribed medications as essential as cardiovascular drugs in the French population. They emphasize that full health coverage should remain a priority for public health policies in this country.
Institut National de la Santé et de la Recherche Médicale, Unité 872, Centre de Recherche des Cordeliers, Paris, France.
Pierre
P
Meneton
Jean-Louis
JL
Lanoe
Joël
J
Ménard
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D005260:Female; D005602:France; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D055815:Young Adult
D002317:Cardiovascular Agents