IDEAS home Printed from https://ideas.repec.org/a/ifs/fistud/v37y2016ip371-403.html
   My bibliography  Save this article

Socio‐Economic Inequalities in Health Care in England

Author

Listed:
  • Eric French
  • Elaine Kelly
  • Richard Cookson
  • Carol Propper
  • Miqdad Asaria
  • Rosalind Raine

Abstract

This paper reviews what is known about socio-economic inequalities in health care in England, with particular attention to inequalities relative to need that may be considered unfair (?inequities?). We call inequalities of 5 per cent or less between the most and least deprived socio-economic quintile groups ?slight?, inequalities of 5?15 per cent ?moderate? and inequalities of more than 15 per cent ?substantial?. Overall public health care expenditure is substantially concentrated on poorer people. At any given age, poorer people are more likely to see their family doctor, have a public outpatient appointment, visit accident and emergency, and stay in hospital for publicly-funded inpatient treatment. After allowing for current self-assessed health and morbidity, there is slight pro-rich inequity in combined public and private medical specialist visits but not in family doctor visits. There are also slight pro-rich inequities in overall indicators of clinical process quality and patient experience from public health care, substantial pro-rich inequalities in bereaved people's experiences of health and social care for recently deceased relatives, and mostly slight but occasionally substantial pro-rich inequities in the use of preventive care (for example, dental check-ups, eye tests, screening and vaccination) and a few specific treatments (for example, hip and knee replacement). Studies of population health care outcomes (for example, avoidable emergency hospitalisation) find substantial pro-rich inequality after adjusting for age and sex only. These findings are all consistent with a broad economic framework that sees health care as just one input into the production of health over the life course, alongside many other socio-economically patterned inputs including environmental factors (for example, living and working conditions), consumption (for example, diet and smoking), self-care (for example, seeking medical information) and informal care (for example, support
(This abstract was borrowed from another version of this item.)

Suggested Citation

  • Eric French & Elaine Kelly & Richard Cookson & Carol Propper & Miqdad Asaria & Rosalind Raine, 2016. "Socio‐Economic Inequalities in Health Care in England," Fiscal Studies, Institute for Fiscal Studies, vol. 37, pages 371-403, September.
  • Handle: RePEc:ifs:fistud:v:37:y:2016:i::p:371-403
    as

    Download full text from publisher

    File URL: http://hdl.handle.net/10.1111/
    Download Restriction: Access to full text is restricted to subscribers.

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Carrieri, Vincenzo & Wuebker, Ansgar, 2013. "Assessing inequalities in preventive care use in Europe," Health Policy, Elsevier, vol. 113(3), pages 247-257.
    2. Laudicella, Mauro & Siciliani, Luigi & Cookson, Richard, 2012. "Waiting times and socioeconomic status: Evidence from England," Social Science & Medicine, Elsevier, vol. 74(9), pages 1331-1341.
    3. Kelly Bedard & Olivier Deschênes, 2006. "The Long-Term Impact of Military Service on Health: Evidence from World War II and Korean War Veterans," American Economic Review, American Economic Association, vol. 96(1), pages 176-194, March.
    4. 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.
    5. Asaria, Miqdad & Doran, Tim & Cookson, Richard, 2016. "The costs of inequality: whole-population modelling study of lifetime inpatient hospital costs in the English National Health Service by level of neighbourhood deprivation," LSE Research Online Documents on Economics 101244, London School of Economics and Political Science, LSE Library.
    6. Johnston, David W. & Propper, Carol & Shields, Michael A., 2009. "Comparing subjective and objective measures of health: Evidence from hypertension for the income/health gradient," Journal of Health Economics, Elsevier, vol. 28(3), pages 540-552, May.
    7. O'Donnell, Owen & Propper, Carol, 1991. "Equity and the distribution of UK National Health Service resources," Journal of Health Economics, Elsevier, vol. 10(1), pages 1-19, May.
    8. Johnston, David W. & Propper, Carol & Pudney, Stephen & Shields, Michael A., 2010. "Is There an Income Gradient in Child Health? It Depends Whom You Ask," IZA Discussion Papers 4830, Institute of Labor Economics (IZA).
    9. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income‐related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 629-647, July.
    10. Dardanoni, Valentino & Wagstaff, Adam, 1990. "Uncertainty and the demand for medical care," Journal of Health Economics, Elsevier, vol. 9(1), pages 23-38, June.
    11. Bago d'Uva, Teresa & Jones, Andrew M. & van Doorslaer, Eddy, 2009. "Measurement of horizontal inequity in health care utilisation using European panel data," Journal of Health Economics, Elsevier, vol. 28(2), pages 280-289, March.
    12. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    13. Elsa Marques & Sian Noble & Ashley W. Blom & William Hollingworth, 2014. "Disclosing Total Waiting Times For Joint Replacement: Evidence From The English Nhs Using Linked Hes Data," Health Economics, John Wiley & Sons, Ltd., vol. 23(7), pages 806-820, July.
    14. Cookson, Richard & Laudicella, Mauro & Donni, Paolo Li, 2012. "Measuring change in health care equity using small-area administrative data – Evidence from the English NHS 2001–2008," Social Science & Medicine, Elsevier, vol. 75(8), pages 1514-1522.
    15. 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.
    16. Sabates, Ricardo & Feinstein, Leon, 2006. "The role of education in the uptake of preventative health care: The case of cervical screening in Britain," Social Science & Medicine, Elsevier, vol. 62(12), pages 2998-3010, June.
    17. van Ryn, Michelle & Burke, Jane, 2000. "The effect of patient race and socio-economic status on physicians' perceptions of patients," Social Science & Medicine, Elsevier, vol. 50(6), pages 813-828, March.
    18. Marion Devaux, 2015. "Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 21-33, January.
    19. Fleurbaey, Marc & Schokkaert, Erik, 2009. "Unfair inequalities in health and health care," Journal of Health Economics, Elsevier, vol. 28(1), pages 73-90, January.
    20. Robert W. Fogel, 2003. "Secular Trends in Physiological Capital: Implications for Equity in Health Care," NBER Working Papers 9771, National Bureau of Economic Research, Inc.
    21. Morris, Stephen & Sutton, Matthew & Gravelle, Hugh, 2005. "Inequity and inequality in the use of health care in England: an empirical investigation," Social Science & Medicine, Elsevier, vol. 60(6), pages 1251-1266, March.
    22. Laura Vallejo‐Torres & Stephen Morris, 2013. "Income‐Related Inequity In Healthcare Utilisation Among Individuals With Cardiovascular Disease In England—Accounting For Vertical Inequity," Health Economics, John Wiley & Sons, Ltd., vol. 22(5), pages 533-553, May.
    23. Andrew Jones, 2004. "Thirteenth European Workshop on Econometrics and Health Economics," Health Economics, John Wiley & Sons, Ltd., vol. 13(1), pages 100-100, January.
    24. Titus J. Galama & Hans van Kippersluis, 2013. "Health Inequalities through the Lens of Health Capital Theory: Issues, Solutions, and Future Directions," Tinbergen Institute Discussion Papers 13-076/V, Tinbergen Institute.
    25. Carol Propper & Richard Upward, 1992. "Need, equity and the NHS: the distribution of health care expenditure 1974-87," Fiscal Studies, Institute for Fiscal Studies, vol. 13(2), pages 1-21, February.
    26. Eric French & Elaine Kelly & Elaine Kelly & George Stoye & Marcos Vera‐Hernández, 2016. "Public Hospital Spending in England: Evidence from National Health Service Administrative Records," Fiscal Studies, Institute for Fiscal Studies, vol. 37, pages 433-459, September.
    27. 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.
    28. 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, September.
    29. James J. Heckman, 2012. "The developmental origins of health," Health Economics, John Wiley & Sons, Ltd., vol. 21(1), pages 24-29, January.
    30. Brittany McKinnon & Sam Harper & Spencer Moore, 2011. "Decomposing income-related inequality in cervical screening in 67 countries," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 56(2), pages 139-152, April.
    31. 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.
    32. Giuseppe Moscelli & Luigi Siciliani & Nils Gutacker & Richard Cookson, 2015. "Socioeconomic Inequality of Access to Healthcare: Does Patients' Choice Explain the Gradient? Evidence from the English NHS," Working Papers 112cherp, Centre for Health Economics, University of York.
    33. Amartya Sen, 2002. "Why health equity?," Health Economics, John Wiley & Sons, Ltd., vol. 11(8), pages 659-666, December.
    34. Balsa, Ana I. & McGuire, Thomas G., 2001. "Statistical discrimination in health care," Journal of Health Economics, Elsevier, vol. 20(6), pages 881-907, November.
    35. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & Citoni, Guido & Di Biase, Rita & Gerdtham, Ulf-G. & Gerfin, Mike & Gross, Lorna & Hakinnen, Unto, 1999. "The redistributive effect of health care finance in twelve OECD countries," Journal of Health Economics, Elsevier, vol. 18(3), pages 291-313, June.
    36. Le Grand, Julian, 1978. "The Distribution of Public Expenditure: The Case of Health Care," Economica, London School of Economics and Political Science, vol. 45(178), pages 125-142, May.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Sveréus, Sofia & Kjellsson, Gustav & Rehnberg, Clas, 2018. "Socioeconomic distribution of GP visits following patient choice reform and differences in reimbursement models: Evidence from Sweden," Health Policy, Elsevier, vol. 122(9), pages 949-956.
    2. Amaral Garcia, Sofia & Nardotto, Mattia & Propper, Carol & Valletti, Tommaso, 2019. "Mums Go Online: Is the Internet Changing the Demand for Healthcare?," CEPR Discussion Papers 13625, C.E.P.R. Discussion Papers.
    3. Magali Duque & Abigail McKnight, 2019. "Understanding the relationship between inequalities and poverty: a review of dynamic mechanisms," CASE Papers /217, Centre for Analysis of Social Exclusion, LSE.
    4. Duque, Magali & Mcknight, Abigail, 2019. "Understanding the relationship between inequalities and poverty: a review of dynamic mechanisms," LSE Research Online Documents on Economics 103457, London School of Economics and Political Science, LSE Library.
    5. Davillas, Apostolos & Pudney, Stephen, 2020. "Biomarkers, disability and health care demand," GLO Discussion Paper Series 517, Global Labor Organization (GLO).
    6. Olsen, Kim Rose & Laudicella, Mauro, 2019. "Health care inequality in free access health systems: The impact of non-pecuniary incentives on diabetic patients in Danish general practices," Social Science & Medicine, Elsevier, vol. 230(C), pages 174-183.

    More about this item

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:ifs:fistud:v:37:y:2016:i::p:371-403. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Emma Hyman). General contact details of provider: http://edirc.repec.org/data/ifsssuk.html .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.