Résumé :
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[BDSP. Notice produite par INIST-CNRS yjgUR0xb. Diffusion soumise à autorisation]. Context : Some have argued that Canada's uniquely restrictive approach to private health insurance keeps the socioeconomic elite inside the public system so that their demands and influence elevate the standard of service for all Canadian citizens. The extent to which this theory is a valid representation of Canadian health care is unknown. Objectives : To explore how patients with acute myocardial infarction from different socioeconomic backgrounds perceive their care in Canada's universal health care system and to correlate patients'backgrounds and perceptions with actual care received. Design, Setting, and Patients : Prospective observational cohort study with follow-up telephone interviews of 2256 patients 30 days following acute myocardial infarction discharged from 53 hospitals across Ontario, Canada, between December 1999 and June 2002. Main Outcome Measures Postdischarge use of cardiac specialty services ; satisfaction with care ; willingness to pay directly for faster service or more choice ; and mortality according to income and education, adjusted for age, sex, ethnicity, clinical factors, on site angiography capacity at the admitting hospital, and rural-urban residence. Results Compared with patients in lower socioeconomic strata, more affluent or better educated patients were more likely to undergo coronary angiography (67.8% vs 52.8% ; P<. receive cardiac rehabilitation vs p or be followed up by a cardiologist socioeconomic differences in care persisted after adjustment for confounders. despite receiving more specialized services patients with higher status were likely to dissatisfied their access specialty rr confidence interval and favor out-of-pocket payments quicker wider selection of treatment options household incomes can less than respectively adjusting baseline characteristics was not significantly associated mortality at year following hospitalization myocardial infarction. conclusions : compared those lower education upper middle-class canadians gain preferential within the publicly funded health system yet remain supplemental coverage direct purchase services.>
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