People with coronary heart disease are more likely to have the condition investigated and treated adequately if they are paying directly for healthcare, according to research presented at the Royal Academy of Medicine in Ireland last night.
Dr John McManus told the meeting that research in his general practice in Bray, Co Wicklow, demonstrated clear inequalities in the care provided. Of 201 patients with coronary heart disease, 70 were randomly selected for an analysis of their investigations and treatment. Thirty of these had been treated in the private system; 40 had medical cards and were seen in public hospitals.
Only 25 per cent of medical card patients had a coronary angiogram [a dye test in which the blockages in the arteries are directly visualised]. The survey showed that 77 per cent of private patients had undergone this definitive investigation. Of 30 private patients, only one did not undergo an exercise electrocardiogram - another basic test of cardiac disease - whereas 15 of the 40 medical card patients had not undergone the test.
"If you are poor, not only are your chances much greater of getting coronary disease in the Republic, your chances of having it investigated and managed adequately are much less. This is a disgrace and reflects badly on the whole health provision system," said Dr McManus.
A further analysis of the data based on sex showed 69 per cent of male patients had undergone angiography compared to 14 per cent of females. In addition, none of the 28 women examined as part of the study had a bypass procedure performed. This compared with a bypass rate of 26 per cent in men.
"I think these are very significant figures," Dr McManus told the meeting, adding that claims by others that coronary heart disease is a totally different disease in women do not fully explain the disparity in treatment demonstrated by his study. "Is it that women are less demanding or for some reason do doctors have a different attitude to women with coronary heart disease?" he asked. He called for further research to address these issues.
He acknowledged that his results represented a small study in one group general practice in one part of the country "served by three public general hospitals and one large private hospital". However, he said, if the results were sustained in a large study "there could be no more eloquent demonstration that once you got coronary heart disease your chances of having it investigated and treated adequately are much greater if you are paying the providers directly".
Dr McManus also criticised the national cardiovascular strategy which "21/2 years on is no nearer to realisation". Referring to a deprived housing estate in Bray with 30 per cent male unemployment, he said he was not surprised to discover that living in such an estate "on its own" may be a risk factor for heart disease. He questioned the reference in the cardiovascular strategy to people needing to make "responsible choices" about their health, adding that the provision of a decent physical and social environment is an important prerequisite for people to be able to make such choices.
"As doctors, we can no longer pretend that issues such as planning, housing, education and income support are somebody else's concern," he said.
Dr McManus was giving the inaugural Irish Times/Royal Academy of Medicine in Ireland lecture. The lecture series continues on November 29th, when the speaker will be Prof Aidan Halligan, director of the National Health Service Clinical Governance Support Team.
Dr John McManus is a general practitioner with one of the largest group GP practices in the Republic. He is a Labour Party member of Bray Urban District Council and is married to Ms Liz McManus, the party's spokeswoman on health.