In-hospital outcomes of percutaneous coronary intervention (PCI) patients with different medical funds: an analysis
Tirawit Hongsakul1, Suppavit Chumsantivut2, Sukanya Siriyotha3
1Division of Cardiovascular Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Insights
Healthcare funding in Thailand impacts percutaneous coronary intervention (PCI) outcomes. Patients under the Government Service Scheme (GS) had better results than those in the Universal Health Coverage (UC) or Social Security Scheme (SS).
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Health Economics
Background:
- Limited data exists on percutaneous coronary intervention (PCI) outcomes across different healthcare funding systems in Thailand.
- Understanding these disparities is crucial for improving patient care and health policy.
Purpose of the Study:
- To investigate the association between in-hospital clinical outcomes of patients undergoing PCI and their respective healthcare funding schemes in Thailand.
- To identify potential disparities in care based on insurance type.
Main Methods:
- Utilized data from the Thai PCI registry, a multicenter prospective national registry (May 2018 - August 2020).
- Analyzed clinical characteristics, management, and in-hospital outcomes of 22,741 patients across four funding groups: UC, GS, SS, and other.
- Adjusted for baseline characteristics and management strategies to compare outcomes.
Main Results:
- Patients in the Social Security Service Scheme (SS) and Universal Health Coverage Scheme (UC) had significantly higher in-hospital Major Adverse Cardiovascular Events (MACE) compared to the Government Service Scheme (GS).
- Post-procedural myocardial infarction rates were elevated across all funding groups.
- No statistically significant differences were observed in all-cause death or cerebrovascular accident/stroke rates between groups.
Conclusions:
- Thai healthcare funding policies are significantly associated with disparities in in-hospital outcomes following PCI.
- The Government Service Scheme (GS) was linked to superior clinical outcomes compared to other funding schemes.
- Policy adjustments are needed to mitigate healthcare disparities and enhance patient outcomes in PCI.
Background:
The limited literature provides minimal information on clinical outcomes among patients undergoing percutaneous coronary intervention (PCI) under different healthcare funding systems, especially in Thailand.
Objective:
The study aimed to investigate the association between in-hospital clinical outcomes of patients treated with PCI and different types of healthcare funding in Thailand.
Method:
The Thai PCI registry is a multicentre, prospective national registry with 39 participating medical centres. Web-based data entry, collected between May 2018 and August 2020, was centrally managed and analysed, providing clinical characteristics, medical management and in-hospital outcomes.
Results:
A total of 22 741 patients were analysed and classified into four groups: the Universal Health Coverage Scheme (UC) (63.1%), Government Service Scheme (GS) (26.8%), Social Security Service Scheme (SS) (6.8%) and other payment fund (3.2%). The SS group was younger and predominantly male, whereas cardiovascular risk factors were higher in the GS group. After adjusting for baseline characteristics and management strategies, in-hospital MACE outcomes of ACS patients were significantly higher in patients in the SS (OR=1.81 (1.38, 2.37), p<0.001) and UC group (OR=1.22 (1.04, 1.44), p=0.017) compared with the GS group. Post-procedural myocardial infarction was also higher across all groups. Though differences in all-cause death and cerebrovascular accident/stroke were not statistically significant.
Conclusion:
Healthcare funding policies in Thailand significantly associated with disparities in-hospital outcomes of patients undergoing PCI. Patients receiving treatment under the GS scheme demonstrated better clinical outcomes compared to other schemes. These findings highlight the need for policy adjustments aimed at reducing healthcare disparities to improve patient outcomes.
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