title: Effective universal health coverage and improved 1-year survival after acute myocardial infarction: the Chilean experience.
abstract: In 2005, Chile implemented a universal system of health guarantees (AUGE) aimed at improving equitable access to quality medical care for priority health conditions, including acute myocardial infarction (MI).
  
  
  OBJECTIVE
  To evaluate 1-year survival in MI patients before and after AUGE.
  
  
  METHODS
  Retrospective cohorts of patients with MI (with and without ST segment elevation) discharged alive from six public hospitals between January 2001-June 2005 (pre-AUGE) and July 2008-March 2009 (post-AUGE). Chilean national mortality and MI Registry (hospital-based) databases were linked using a unique identification number (ICD-10 codes I00-I99 were used to identify cardiovascular deaths). One-year survival was assessed using Weibull multivariate regression.
  
  
  RESULTS
  About 1867 patients were discharged alive pre-AUGE and 534 post-AUGE; 25% were women in both periods. When comparing pre-AUGE and post-AUGE, there was an increase in the use of primary and elective angioplasty (1.7 vs 23.6% and 7.3 vs 20.0%), beta-blockers (62 vs 71%) and statins (40 vs 90%); P  <  0.001 all. One-year survival was 92% pre-AUGE (95% CI: 91-93%) and 96% post-AUGE (95% CI: 94-97%) (HR  =  0.50, 95% CI: 0.31-0.82; P  =  0.003). The post-AUGE improvement persisted after adjusting for variables associated with long-term case-fatality (HR  =  0.44, 95% CI: 0.26-0.75). Percutaneous coronary intervention (HR  =  0.31, 95% CI: 0.09-0.99) and statins use at discharge (HR  =  0.45, 95% CI: 0.31-0.66) had the highest effects associated with lower case-fatality and both treatments increased in the post-AUGE period.
  
  
  CONCLUSIONS
  The implementation of AUGE in Chile appears to have contributed to improved treatment of MI in public hospitals and increased 1-year survival, which is consistent with its aim to improve access to quality medical care and to reduce health inequities.
authors.affiliation: School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile and cnazzal@med.uchile.cl.
authors.forename: Carolina
authors.initials: C
authors.lastname: Nazzal
authors.affiliation: School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile and.
authors.forename: Patricia
authors.initials: P
authors.lastname: Frenz
authors.affiliation: School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile and.
authors.forename: Faustino T
authors.initials: FT
authors.lastname: Alonso
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, University of La Frontera, Temuco, Chile.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lanas
mesh_terms: D000368:Aged; D002677:Chile; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011787:Quality of Health Care; D012189:Retrospective Studies; D015996:Survival Rate; D019472:Universal Health Insurance
keywords: Acute myocardial infarction; Chile; equity; health care guarantees; health reform; secondary prevention; survival; universal health coverage