[Equity and variability in the use of medical technologies].

Published in this issue of the REVISTA ESPAÑOLA DE CARDIOLOGÍA, “Variations Among Spanish Regions in the Use of Three Cardiovascular Technologies,” by FitchWarner, García de Yébenes, Lázaro and de Mercado, and Belaza-Santurde.1 The authors highlight a statistical finding in their article: the linear dependency of the use of three therapeutic cardiovascular technologies (percutaneous coronary intervention, implantable cardioverter-defibrillators, and cardiac resynchronization therapy) with the wealth of the region where they are implemented. They also stress that this linear relationship is very weak in relation to disease burden, that is, with the epidemiological variables. Taking this as the starting point, their article points out that the differences in access are still explained by socioeconomic inequalities and not by health needs or disease burden. Thus, they draw our attention to the principle of equity defined as “equal access for equal needs” and point out that, in the case of the technologies studied, inequity exists (although they also emphasize that this statement should be taken with caution because of the way access and need indicators have been defined). This kind of research belongs to a line of studies investigating other areas in the field of cardiology, both in national and international contexts. This is the case with studies focusing on technologies such as angioplasty,2 coronary angiography,3 and defibrillators,4 and analysis studies that assess variations in medical practice in treating acute myocardial infarction5,6 and heart failure.7 Studies on equity of access to other programs or technologies have also been undertaken in other fields such as early breast cancer detection and access to mammography.8,9 The results obtained from such studies allow healthcare authorities and healthcare service managers to become aware of these situations and their possible causes, so that healthcare policies can be readjusted whenever necessary to correct inequalities and unjustified variations in medical practice. Equity and Variability in the Use of Medical Technologies