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Socioeconomic Inequality of Access to Healthcare: Does Patients' Choice Explain the Gradient? Evidence from the English NHS

Author

Listed:
  • Giuseppe Moscelli

    (Centre for Health Economics, University of York, UK)

  • Luigi Siciliani

    (Department of Economics and Related Studies, University of York, UK)

  • Nils Gutacker

    (Centre for Health Economics, University of York, UK)

  • Richard Cookson

    (Centre for Health Economics, University of York, UK)

Abstract

Equity of access is a key policy objective in publicly-funded healthcare systems. Using data on patients undergoing non-emergency heart revascularization procedures in the English National Health Service, we find evidence of significant differences in waiting times within public hospitals between patients with different socioeconomic status (up to 35% difference between the most and least deprived population quintiles). We employ selection models to test whether such differences are explained by patients exercising choice over hospital or type of treatment. Selection bias due to choice has a limited effect on the gradient suggesting the presence of substantial inequities within the public system.

Suggested Citation

  • 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.
    • Handle: RePEc:chy:respap:112cherp
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    File URL: http://www.york.ac.uk/media/che/documents/papers/researchpapers/CHERP112_socioeconomic_inequality_access_healthcare.pdf
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    References listed on IDEAS

    as
    1. Dubin, Jeffrey A & McFadden, Daniel L, 1984. "An Econometric Analysis of Residential Electric Appliance Holdings and Consumption," Econometrica, Econometric Society, vol. 52(2), pages 345-362, March.
    2. François Bourguignon & Martin Fournier & Marc Gurgand, 2007. "Selection Bias Corrections Based On The Multinomial Logit Model: Monte Carlo Comparisons," Journal of Economic Surveys, Wiley Blackwell, vol. 21(1), pages 174-205, February.
    Full references (including those not matched with items on IDEAS)

    Citations

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    Cited by:

    1. 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.
    2. Walter Beckert & Elaine Kelly, 2021. "Divided by choice? For‐profit providers, patient choice and mechanisms of patient sorting in the English National Health Service," Health Economics, John Wiley & Sons, Ltd., vol. 30(4), pages 820-839, April.
    3. Tayyari Dehbarez, Nasrin & Gyrd-Hansen, Dorte & Uldbjerg, Niels & Søgaard, Rikke, 2018. "Does free choice of hospital conflict with equity of access to highly specialized hospitals? A case study from the Danish health care system," Health Policy, Elsevier, vol. 122(7), pages 722-727.
    4. Siciliani, L., 2016. "Waiting Time Policies in the Health Sector," Seminar Briefing 001724, Office of Health Economics.
    5. Manuel Martínez-Blanes & Francisco Javier Rondán-Cataluña & José Manuel Velarde-Gestera, 2020. "Indicators of Efficiency in the Pharmaceutical Management of a Public Health System," Administrative Sciences, MDPI, vol. 10(2), pages 1-19, May.

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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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