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Socioeconomic inequality of access to healthcare: Does choice explain the gradient?

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  • Moscelli, Giuseppe
  • Siciliani, Luigi
  • Gutacker, Nils
  • Cookson, Richard

Abstract

Equity of access is a key policy objective in publicly-funded healthcare systems. However, observed inequalities of access by socioeconomic status may result from differences in patients’ choices. Using data on non-emergency coronary revascularisation procedures in the English National Health Service, we found substantive differences in waiting times within public hospitals between patients with different socioeconomic status: up to 35% difference, or 43 days, between the most and least deprived population quintile groups. Using selection models with differential distances as identification variables, we estimated that only up to 12% of these waiting time inequalities can be attributed to patients’ choices of hospital and type of treatment (heart bypass versus stent). Residual inequality, after allowing for choice, was economically significant: patients in the least deprived quintile group benefited from shorter waiting times and the associated health benefits were worth up to £850 per person.

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  • Moscelli, Giuseppe & Siciliani, Luigi & Gutacker, Nils & Cookson, Richard, 2018. "Socioeconomic inequality of access to healthcare: Does choice explain the gradient?," Journal of Health Economics, Elsevier, vol. 57(C), pages 290-314.
  • Handle: RePEc:eee:jhecon:v:57:y:2018:i:c:p:290-314
    DOI: 10.1016/j.jhealeco.2017.06.005
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    2. Halla, Martin & Kah, Christopher & Sausgruber, Rupert, 2021. "Testing for Ethnic Discrimination in Outpatient Health Care: Evidence from a Field Experiment in Germany," Department of Economics Working Paper Series 319, WU Vienna University of Economics and Business.
    3. Felipa de Mello-Sampayo, 2020. "Spatial Interaction Model for Healthcare Accessibility: What Scale Has to Do with It," Sustainability, MDPI, vol. 12(10), pages 1-19, May.
    4. Nicolai Fink Simonsen & Anne Sophie Oxholm & Søren Rud Kristensen & Luigi Siciliani, 2020. "What explains differences in waiting times for health care across socioeconomic status?," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1764-1785, December.
    5. Martin, Steve & Siciliani, Luigi & Smith, Peter, 2020. "Socioeconomic inequalities in waiting times for primary care across ten OECD countries," Social Science & Medicine, Elsevier, vol. 263(C).
    6. Nasrin Tayyari Dehbarez & Morten Raun Mørkbak & Dorte Gyrd-Hansen & Niels Uldbjerg & Rikke Søgaard, 2018. "Women’s Preferences for Birthing Hospital in Denmark: A Discrete Choice Experiment," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 11(6), pages 613-624, December.
    7. Oxholm, Anne Sophie & Kristensen, Søren Rud & Sutton, Matt, 2018. "Uncertainty about the effort–performance relationship in threshold-based payment schemes," Journal of Health Economics, Elsevier, vol. 62(C), pages 69-83.
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    9. Joana Cima & Álvaro Almeida, 2022. "The impact of cancellations in waiting times analysis: evidence from scheduled surgeries in the Portuguese NHS," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(1), pages 95-104, February.
    10. Silvia Angerer & Christian Waibel & Harald Stummer, 2019. "Discrimination in Health Care: A Field Experiment on the Impact of Patients’ Socioeconomic Status on Access to Care," American Journal of Health Economics, MIT Press, vol. 5(4), pages 407-427, Fall.
    11. Fries, Jonathan & Pietschnig, Jakob, 2022. "An intelligent mind in a healthy body? Predicting health by cognitive ability in a large European sample," Intelligence, Elsevier, vol. 93(C).
    12. Amber Sacre & Clare Bambra & Josephine M. Wildman & Katie Thomson & Sarah Sowden & Adam Todd, 2022. "Socioeconomic Inequalities and Vaccine Uptake: An Umbrella Review Protocol," IJERPH, MDPI, vol. 19(18), pages 1-11, September.
    13. Lippi Bruni, Matteo & Ugolini, Cristina & Verzulli, Rossella, 2021. "Should I wait or should I go? Travelling versus waiting for better healthcare," Regional Science and Urban Economics, Elsevier, vol. 89(C).
    14. Jian Zhou & Chuhan Wang & Xinyu Zhang & Shuang Wang, 2022. "Public Health System and Socio-Economic Development Coupling Based on Systematic Theory: Evidence from China," Sustainability, MDPI, vol. 14(19), pages 1-14, October.
    15. Joana Cima & Paulo Guimarães & Álvaro Almeida, 2018. "Explaining the gender gap in waiting times for scheduled surgery in the Portuguese National Health Service," FEP Working Papers 607, Universidade do Porto, Faculdade de Economia do Porto.
    16. Magdalena Tuczyńska & Rafał Staszewski & Maja Matthews-Kozanecka & Ewa Baum, 2022. "Impact of Socioeconomic Status on the Perception of Accessibility to and Quality of Healthcare Services during the COVID-19 Pandemic among Poles—Pilot Study," IJERPH, MDPI, vol. 19(9), pages 1-10, May.
    17. Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani, 2018. "Effects of Market Structure and Patient Choice on Hospital Quality for Planned Patients," School of Economics Discussion Papers 1118, School of Economics, University of Surrey.
    18. Wilf - Miron, Rachel & Novikov, Ilya & Ziv, Arnona & Mandelbaum, Avishai & Ritov, Yaacov & Luxenburg, Osnat, 2020. "A novel methodology to measure waiting times for community-based specialist care in a public healthcare system," Health Policy, Elsevier, vol. 124(8), pages 805-811.
    19. Turner, Alex J & Francetic, Igor & Watkinson, Ruth & Gillibrand, Stephanie & Sutton, Matt, 2022. "Socioeconomic inequality in access to timely and appropriate care in emergency departments," Journal of Health Economics, Elsevier, vol. 85(C).
    20. Bing Hu & Daiyan Peng & Yuedong Zhang & Jiyu Yu, 2020. "Rural Population Aging and the Hospital Utilization in Cities: The Rise of Medical Tourism in China," IJERPH, MDPI, vol. 17(13), pages 1-17, July.

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    More about this item

    Keywords

    Waiting times; Inequalities; Socioeconomic status; Selection bias; Choice;
    All these keywords.

    JEL classification:

    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • C34 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Truncated and Censored Models; Switching Regression Models

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