Disease, Disability, and Paternalism in the Fight for Medicare for All

The sick and disabled need true co-conspirators who hold politicians accountable, who value the sick and disabled as expert strategists speaking to the needs of the community; who understand and amplify our urgency and our anger. We need universal, single-payer health care—comprehensive care for all, regardless of income or health status—now.

Racial/ethnic differences in cardiovascular outcomes in a universal healthcare system: insights from the CARTaGENE cohort

Background While prior studies have shown racial/ethnic differences in cardiovascular (CV) outcomes within private or mixed health care systems, it remains uncertain whether inequalities in cardiovascular outcomes exist between different races and ethnicities in universal health care contexts. We aimed to determine whether there are racial/ethnicity disparities in long-term CV outcomes within a single-payer universal health care system. Methods The CARTaGENE study is a population-based prospective cohort study with enrollment of 19,996 individuals between 40–69 years in 2009, in the province of Quebec, Canada. Participants residing in four large metropolitan areas were randomly chosen from the provincial health insurance registry by strata of age, sex, and postal codes. Follow-up was available up to 2016. For this analysis, we retained only participants without prior known CV disease. The primary composite endpoint was time to the first CV event or intervention (CV death, acute coronary syndrome, heart failure, coronary revascularization, ischemic stroke, or peripheral vascular event or revascularization). We used unadjusted and adjusted Cox proportional hazard models to evaluate the association of self-defined race/ethnicity with the primary endpoint. Results There were 17,802 eligible participants with a mean age of 51 years (52.5% females) with 111,312 person-years of follow-up (median follow-up of 6.6 years). South Asian (SA) participants had the highest prevalence of diabetes mellitus (29%) and hypertension (32%). After adjustment for age and sex, SA ethnicity was associated with a 95% relative increase in risk for CV events, while East/Southeast Asian (ESA) ethnicity was associated with a 42% relative decrease in risk for CV events compared to White participants. After further adjustment for socioeconomic status and CV risk factors, ESA ethnicity remained associated with a similar decreased CV risk. In contrast, the association of SA ethnicity with increased CV risk was attenuated after full adjustment for baseline characteristics (Table 1). Conclusions Racial/ethnic disparities in long-term CV outcomes are present in a single-payer universal healthcare setting. ESA ethnicity was associated with a lower risk of long-term CV outcomes. Future studies are needed to corroborate the reduced risk of long-term major CV events associated with ESA ethnicity. Understanding the reasons related to potential CV protection with ESA ethnicity could facilitate endeavors to reduce long-term CV outcomes in other races/ethnicities. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): McGill Health University Center

Determinants of healthcare quality in single-payer healthcare system countries

Background: The quality of healthcare system in any country is essential for the wellbeing of its population. Improving the quality of the healthcare sector would lead to a healthier population and thus more productive nation and stronger economy. The level of healthcare quality depends on both economic and non-economic factors. Addressing the level of effect these factors on healthcare quality would facilitate policy makers’ tasks in achieving that goal.Method: This study is based on the 2019 data of 29 countries that adapt single-payer healthcare system. Pearson correlation matrix is used to examine the relation of a number of variables with healthcare quality, measured by life expectancy, in these countries.Results: The results from this research showed that literacy rate, digital adaptation, pollution level, corruption level, healthcare expenditure (HE) per capita, GDP per capita, healthcare expenditure as a percentage of GDP all showed a strong relation at the 99% confidence level while the number of physicians per 1000 showed statistically significant relation with healthcare quality at the 95% confidence level. While all factors showed direct relation, pollution and corruption showed an inverse relation.Conclusions: Improving the quality of the healthcare sector is the goal of any government since it would lead to better and stronger economy. While economic factors play a role in achieving that goal, other non-economic factors can also have the same effect in achieving that goal.