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Equity of access to health care services: : Theory and evidence from the UK

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  • Goddard, Maria
  • Smith, Peter
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    Abstract

    The pursuit of equity of access to health care is a central objective of many health care systems. This paper first sets out a general theoretical framework within which equity of access can be examined. It then applies the framework by examining the extent to which research evidence has been able to detect systematic inequities of access in UK, where equity of access has been a central focus in the National Health Service since its inception in 1948. Inequity between socio-economic groups is used as an illustrative example, and the extent of inequity of access experienced is explored in each of five service areas: general practitioner consultations; acute hospital care; mental health services; preventative medicine and health promotion; and long-term health care. The paper concludes that there appear to be important inequities in access to some types of health care in the UK, but that the evidence is often methodologically inadequate, making it difficult to draw firm conclusions. In particular, it is difficult to establish the causes of inequities which in turn limits the scope for recommending appropriate policy to reduce inequities of access. The theoretical framework and the lessons learned from the UK are of direct relevance to researchers from other countries seeking to examine equity of access in a wide variety of institutional settings.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 53 (2001)
    Issue (Month): 9 (November)
    Pages: 1149-1162

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    Handle: RePEc:eee:socmed:v:53:y:2001:i:9:p:1149-1162

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    Related research

    Keywords: Equity Access Socio-economic group Methodology UK;

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    Cited by:
    1. Fichera, Eleonora & Sutton, Matt, 2011. "State and self investments in health," Journal of Health Economics, Elsevier, vol. 30(6), pages 1164-1173.
    2. Alessio Petrelli & Roberta Picariello & Giuseppe Costa, 2010. "Toward a needs based mechanism for capitation purposes in Italy: the role of socioeconomic level in explaining differences in the use of health services," International Journal of Health Care Finance and Economics, Springer, vol. 10(1), pages 29-42, March.
    3. Ellen van de Poel & Eddy van Doorslaer & Owen O'Donnell, 2011. "Measurement of Inequity in Health Care with Heterogeneous Response of Use to Need," Tinbergen Institute Discussion Papers 11-155/3, Tinbergen Institute.
    4. Channon, Andrew Amos & Andrade, Monica Viegas & Noronha, Kenya & Leone, Tiziana & Dilip, T.R., 2012. "Inpatient care of the elderly in Brazil and India: Assessing social inequalities," Social Science & Medicine, Elsevier, vol. 75(12), pages 2394-2402.
    5. Cormac O'Dea & Ian Preston, 2012. "The distributional impact of public spending in the UK," IFS Working Papers W12/06, Institute for Fiscal Studies.
    6. Teresa Bago d'Uva, 2005. "Latent class models for use of primary care: evidence from a British panel," Health Economics, John Wiley & Sons, Ltd., vol. 14(9), pages 873-892.
    7. FLEURBAEY, Marc & SCHOKKAERT, Erik, 2007. "Unfair inequalities in health and health care," CORE Discussion Papers 2007090, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    8. Luo, Juhua & Zhang, Xiulan & Jin, Chenggang & Wang, Dongmin, 2009. "Inequality of access to health care among the urban elderly in northwestern China," Health Policy, Elsevier, vol. 93(2-3), pages 111-117, December.
    9. Carol Propper & Jenny Eachus & Philip Chan & Nicky Pearson & George Davey Smith, 2005. "Access to health care resources in the UK: the case of care for arthritis," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 391-406.
    10. Olena Kalinichenko & Carla A. F. Amado & Sérgio P. Santos, 2013. "Performance Assessment in Primary Health Care: A Systematic Literature Review," CEFAGE-UE Working Papers 2013_03, University of Evora, CEFAGE-UE (Portugal).
    11. Iversen, Tor & Kopperud, Gry Stine, 2009. "Regulation versus practice - The impact of accessibility on the use of specialist health care in Norway," HERO On line Working Paper Series 2005:2, Oslo University, Health Economics Research Programme.
    12. Ellen van de Poel & Eddy van Doorslaer & Owen O'Donnell, 2011. "Measurement of Inequity in Health Care with Heterogeneous Response of Use to Need," Tinbergen Institute Discussion Papers 11-155/3, Tinbergen Institute.
    13. Amedeo Spadaro & Lucia Mangiavacchi & Ignacio Moral-Arce & Marta Adiego-Estella & Angela Blanco-Moreno, 2013. "Evaluating the redistributive impact of public health expenditure using an insurance value approach," The European Journal of Health Economics, Springer, vol. 14(5), pages 775-787, October.
    14. Laia Palència & Albert Espelt & Maica Rodríguez-Sanz & Katia B. Rocha & M. Isabel Pasarín & Carme Borrell, 2013. "Trends in social class inequalities in the use of health care services within the Spanish National Health System, 1993–2006," The European Journal of Health Economics, Springer, vol. 14(2), pages 211-219, April.
    15. Adam Oliver, 2005. "The English National Health Service: 1979-2005," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages S75-S99.
    16. Iversen, Tor & Kopperud, Gry Stine, 2009. "The impact of accessibility on the use of specialist health care in Norway," HERO On line Working Paper Series 2002:9, Oslo University, Health Economics Research Programme.
    17. Pizer, Steven D. & Prentice, Julia C., 2011. "Time is money: Outpatient waiting times and health insurance choices of elderly veterans in the United States," Journal of Health Economics, Elsevier, vol. 30(4), pages 626-636, July.

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