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High income heart attack survivors receive more care, but still want private services


High income, better-educated heart attack survivors receive more cardiac services, yet many are dissatisfied with their care, and a small minority are willing to pay for private health services, a new study from the Institute for Clinical Evaluative Sciences (ICES) has found.

Researchers surveyed over 2,200 Ontario heart attack patients 30 days following their heart attack between 1999 and 2002 to find out about post-hospital discharge use of cardiac specialty services, satisfaction with care, and willingness to pay direct for faster service or more choice.

The results showed that, compared to patients of lower socioeconomic (SES) status, more affluent and better-educated patients were more likely to undergo coronary angiography (68% vs. 53%), receive cardiac rehabilitation (44% vs. 26%), or be followed up by a cardiologist (57% vs. 48%). In addition, 30% of patients with incomes greater than $60,000 favoured out-of-pocket payments for quicker access to a wider selection of treatment options, compared to just 15% for people with incomes less than $30,000.

“Our study contributes to a growing body of knowledge showing inequities in our health system and adds to the on-going debate within our society about whether banning privatization is good or bad for universal healthcare,” said lead author and ICES scientist Dr. David Alter.

“These findings can be used by those who support Canada's uniquely restrictive approach to private health insurance, or by those who believe the ban on private care should be eased," Dr Alter noted.

"Some see the wealthy patients who get better access to specialized services as 'canaries in the coal-mine', making the system better for everyone with their high standards and demands. Others will see them as competing for scarce resources in the public system against disadvantaged patients who have a higher burden of illness."

Dr. Alter pointed out that although Canadians are understandably attached to the current model of Medicare, many other nations do maintain high-quality universal publicly financed healthcare systems without banning all forms of parallel private insurance.

The study, “Socioeconomic status, service patterns, and perceptions of care among survivors of acute myocardial infarction in Canada”, is in the March 3, 2004 issue of the Journal of the American Medical Association (JAMA).

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measure of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners and practitioners to make decisions about care delivery and to develop policy.


  • Julie Argles
  • Media Relations Officer, ICES
  • (416) 480-4055 ext. 3602 or cell (416) 432-8143


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