Full coverage for hypertension drugs in rural communities in China

The control rate for hypertension is unacceptably low worldwide, and poor adherence to medication is a primary reason.

To evaluate the impact of full coverage for hypertension drugs on adherence to medication, medical costs, and hypertension control in Shandong Province, China.

In November 2009, we interviewed 110 hypertensive patients who had been participating in a free medication program since May 2008 and 241 hypertensive patients who were not participating. We used a 1:1 propensity-score matching technique to obtain matched samples of 102 program participants (intervention) and 102 nonparticipants (control). We used univariate analysis to compare patient drug-taking behaviors, medical costs, and hypertension control between the 2 groups.

All intervention patients took > 1 drugs for hypertension control and 93% of them took > 3 such drugs, 15 control patients (15%) did not take any, and only 39% took 3 or more (P < .001). Three-fourths (75%) of the intervention patients took the prescribed drugs regularly, whereas 66% of the control group (P = .034) did so. Participation in the program was associated with lower annual out-of-pocket medical costs both overall and for outpatient services (P < .001 for both).

Low-income rural residents in China receiving free drugs had enhanced medication adherence and reduced total medical costs. Providing hypertension drugs at no charge may be a promising strategy for preventing costly cardiovascular events associated with hypertension in China and other parts of the world with growing rates of cardiovascular disease.