Economic policies can potentially influence the management and control of hypertension, according to a recent review of evidence on the association between these policies and hypertension management in US adults. The investigation included a range of study types, such as randomized clinical trials and interrupted time series studies, which evaluated how economic policies impact hypertension management.
The policies were grouped into three main categories: insurance coverage expansion like Medicaid expansion, cost-sharing in healthcare such as increased drug copayments, and financial incentives for quality like pay-for-performance. The study assessed the impact of these policies on antihypertensive treatment, which was measured as taking antihypertensive medications or medication adherence among those diagnosed with hypertension. It also evaluated hypertension control, measured as blood pressure lower than 140/90 mm Hg or a reduction in blood pressure.
The review included a total of 31 articles, with none of the studies examining economic policies outside of the healthcare system. More than half of the studies assessed policies for insurance coverage expansion, while a quarter evaluated policies related to patient cost sharing for prescription drugs, and the rest evaluated financial incentive programs for improving healthcare quality.
Economic Policies Boost Hypertension Treatment Success, But Challenges Remain with Cost-Sharing
Almost all of the studies that evaluated coverage expansion policies found significant improvement in antihypertensive treatment and blood pressure control. However, half of the studies examining patient cost sharing found that measures such as prior authorization and increased copayments were associated with decreased medication adherence. On the other hand, all studies evaluating financial incentives aimed at improving quality found that they improved antihypertensive treatment and blood pressure control.
In conclusion, the findings suggest that economic policies aimed at expanding insurance coverage or improving healthcare quality successfully improved medication use and blood pressure control among US adults with hypertension. However, future research is needed to explore the potential effects of non-healthcare economic policies on hypertension control.
Original Article DOI: 10.1001/jamahealthforum.2023.5231
Original title: Association of Economic Policies With Hypertension Management and Control: A Systematic Review
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