85 Medication use by insurance coverage in the Southern Cone of Latin America 4 INTRODUCTION Coronary heart disease (CHD) is the main cause of death globally and also in the southern region of Latin America, where 12.4% of all deaths are caused by CHD (1). Individuals with established CHD are at very high cardiovascular risk and clinical guidelines recommend that they use cardioprotective medication to reduce morbidity and mortality. However, previous research points towards a gap in medications used for secondary prevention of coronary heart disease globally (2–6) and in the South American region (7). Individuals with lower socioeconomic status (SES) are less likely to use guidelinerecommended medications (7–10) even though they are generally at higher risk for cardiovascular morbidity and mortality (11,12). A potential contributor to the lower use of these medications in the low SES population is insurance coverage. In general lines, the healthcare systems in Argentina, Chile and Uruguay are organized in public, social security and private sectors (13). The public sector covers the whole population, but some individuals rely solely on this sector, as they do not have additional insurance. These individuals usually have low SES, such as individuals working in the informal economy. The social security sector is organized by various social security plans, it is financed through salary deductions, and it generally covers the population with formal employment, their families, and retired people. Private medicine companies generally cater for those with higher SES and require to pay health services out of pocket or an insurance premium (Figure 1) (14–17). There may be differences with the services that are offered between the three sectors, and effective coverage in practice is considered inadequately distributed (18). However, the sectors are not completely separated: certain services are hired to other sectors according to their capacity and needs. While basic services are provided in the public sector, users might find it challenging to find complex care, and inequalities in access and quality of care may occur (19). Medication costs also differ by sector. The population covered by the public sector and to some extent those with additional coverage, are provided with some medications free of charge by Sistema Integrado de Salud (SIS) in Uruguay and the program Remediar in Argentina, and with discounts in Chile through the program Plan de Acceso Universal con Garantías Explícitas (AUGE). In the social security sector, providers offer co-payments of varying amounts depending on the plan and the medication. In the private sector, similarly, the extent of coverage of the medication costs depends on the plan and the individual’s contributions (Figure 1) (15–17).
RkJQdWJsaXNoZXIy MTk4NDMw