94 Chapter 4 public and social security sectors have different medicines list to provide free of charge (16); and in Chile the AUGE program includes limits to co-payments (17). In the private sector, the services and medications also differ per plan and depend on the contributions in the premiums, and thus on the payment capacity of users (22). Barriers in medication use In our study, we find that more participants in the public sector report not receiving necessary care compared to those with additional coverage. Further, the most common reported barriers among diabetic subjects in the CESCAS Study were related to waiting times and cost of care (13). Becerril et al (17) described that Chileans face high co-payments for medication despite pharmacy programs. Given the importance of outpatient visits for risk factor management, and of long-term medication use in people with CHD, it is concerning that almost 10% of the participants with CHD in this study could not make an appointment fast enough and could not afford drugs. It might seem contradictory that insurance type was associated with facing barriers to needed care (including affording medications), but it was not associated with the use of medications. It is possible that participants in the public sector, despite facing barriers to access care, make additional efforts to access the medications due to the importance of treatment given their diagnosis. Nevertheless, with the existing data we are not able to assess if the reported barriers and medication were related to CHD. Therefore, the barriers to care and medication reported by subjects with CHD in this region require further research. Current situation The CESCAS baseline data was collected in 2010-2011. Since then, more medications have been included in the pharmacy programmes in the Southern Cone of Latin America. Importantly, cardiovascular drugs like ARBs were added to the Remediar program in 2010 (37). In 2014, the program Fondo de Farmacia was implemented in Chile, which provides free medications for hypertension, diabetes and hypercholesterolemia in the public sector (38). The social security plan in Argentina for the retired (the largest social security plan in the country) covers the full cost of 170 essential medications since 2020 (22). These changes are implemented to improve access to medication and reduce inequalities in medication use. Nevertheless, the fragmentation of healthcare systems remains a challenge for equitable access to cardioprotective medication. Strengths and limitations This is the first study to investigate possible inequalities in medication use by coverage in a community setting in the Southern Cone of Latin America. However, our analysis presents several limitations. First, the sample size was limited as we studied participants with a CHD diagnosis and information on insurance coverage. Second, the information on CHD diagnosis and medication use was self-reported. Further, participants were asked which medications they were using, but not how they accessed them. Therefore, it is possible that people with a certain coverage acquired medication through another subsector, which would dilute
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