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Inequity and inequality in the use of health care in England: an empirical investigation

Listed author(s):
  • Morris, Stephen
  • Sutton, Matthew
  • Gravelle, Hugh

Achieving equity in healthcare, in the form of equal use for equal need, is an objective of many healthcare systems. The evaluation of equity requires value judgements as well as analysis of data. Previous studies are limited in the range of health and supply variables considered but show a pro-poor distribution of general practitioner consultations and inpatient services and a pro-rich distribution of outpatient visits. We investigate inequality and inequity in the use of general practitioner consultations, outpatient visits, day cases and inpatient stays in England with a unique linked data set that combines rich information on the health of individuals and their socio-economic circumstances with information on local supply factors. The data are for the period 1998-2000, just prior to the introduction of a set of National Health Service (NHS) reforms with potential equity implications. We find inequalities in utilisation with respect to income, ethnicity, employment status and education. Low-income individuals and ethnic minorities have lower use of secondary care despite having higher use of primary care. Ward level supply factors affect utilisation and are important for investigating health care inequality. Our results show some evidence of inequity prior to the reforms and provide a baseline against which the effects of the new NHS can be assessed.

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File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(04)00356-9
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Article provided by Elsevier in its journal Social Science & Medicine.

Volume (Year): 60 (2005)
Issue (Month): 6 (March)
Pages: 1251-1266

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Handle: RePEc:eee:socmed:v:60:y:2005:i:6:p:1251-1266
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  1. Adamson, Joy & Ben-Shlomo, Yoav & Chaturvedi, Nish & Donovan, Jenny, 2003. "Ethnicity, socio-economic position and gender--do they affect reported health--care seeking behaviour?," Social Science & Medicine, Elsevier, vol. 57(5), pages 895-904, September.
  2. Smaje, Chris & Le Grand, Julian, 1997. "Ethnicity, equity and the use of health services in the British NHS," Social Science & Medicine, Elsevier, vol. 45(3), pages 485-496, August.
  3. Adam Wagstaff & Eddy van Doorslaer, 2000. "Measuring and Testing for Inequity in the Delivery of Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 35(4), pages 716-733.
  4. Ignacio Abasolo & Rob Manning & Andrew Jones, 2001. "Equity in utilization of and access to public-sector GPs in Spain," Applied Economics, Taylor & Francis Journals, vol. 33(3), pages 349-364.
  5. Sutton, Matthew & Carr-Hill, Roy & Gravelle, Hugh & Rice, Nigel, 1999. "Do measures of self-reported morbidity bias the estimation of the determinants of health care utilisation?," Social Science & Medicine, Elsevier, vol. 49(7), pages 867-878, October.
  6. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & De Graeve, Diana & Duchesne, Inge & Gerdtham, Ulf-G & Gerfin, Michael & Geurts, Jose & Gross, Lorna, 2000. "Equity in the delivery of health care in Europe and the US," Journal of Health Economics, Elsevier, vol. 19(5), pages 553-583, September.
  7. Matthew Sutton, 2002. "Vertical and horizontal aspects of socio-economic inequity in general practitioner contacts in Scotland," Health Economics, John Wiley & Sons, Ltd., vol. 11(6), pages 537-549.
  8. Goddard, Maria & Smith, Peter, 2001. "Equity of access to health care services: : Theory and evidence from the UK," Social Science & Medicine, Elsevier, vol. 53(9), pages 1149-1162, November.
  9. Mooney, Gavin & Hall, Jane & Donaldson, Cam & Gerard, Karen, 1991. "Utilisation as a measure of equity: weighing heat?," Journal of Health Economics, Elsevier, vol. 10(4), pages 475-480.
  10. McClements, L. D., 1977. "Equivalence scales for children," Journal of Public Economics, Elsevier, vol. 8(2), pages 191-210, October.
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