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Equity of access to health care


  • Maria Goddard

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

  • Peter Smith



The election of the Labour government last year shifted the issue of inequality in health to the top of the policy agenda. In its White Paper on the “New NHS”, promises were made about reducing unacceptable variations in services and ensuring fair access. Publication of the Green Paper “Our Healthier Nation” also reinforced the government’s aim of narrowing the health gap. Several national initiatives also have this aim, including the £30 million investment in Health Action Zones which are to target health inequalities and the establishment of a public enquiry into health inequalities, chaired by Sir Donald Acheson. However, much of the action required to tackle inequality will have to be undertaken at a local level. Indeed, the White Paper gave Health Authorities, in conjunction with other organisations inside and outside the NHS, the key task of improving health and reducing inequalities through their Health Improvement Programmes. If this task is to me manageable, those in the NHS will need to disentangle the many and complex stands involved in understanding the issue of inequality in health. This report attempts to clarify what is known in relationship to one of those issues – equity of access to health care services – and to draw out the policy implications of the research on this topic. Following an overview of methodological issues, research evidence on the extent and cause of inequities of access to services in the following five areas is summarised and analysed: GP consultations, acute care, mental illness, prevention and health promotion and long-term care. The policy and research implications are drawn out and some suggestions for future directions are made. The report is aimed at both policy makers and academics interested in the state of existing research and in designing and implementing their own studies into equity of access.

Suggested Citation

  • Maria Goddard & Peter Smith, 1998. "Equity of access to health care," Working Papers 032cheop, Centre for Health Economics, University of York.
  • Handle: RePEc:chy:respap:32cheop

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    References listed on IDEAS

    1. Le Grand, Julian, 1991. "The distribution of health care revisited: A commentary on Wagstaff, van Doorslaer and Paci, and O'Donnell and Propper," Journal of Health Economics, Elsevier, vol. 10(2), pages 239-245, July.
    2. Martin, Stephen & Smith, Peter, 1996. "Explaining variations in inpatient length of stay in the National Health Service," Journal of Health Economics, Elsevier, vol. 15(3), pages 279-304, June.
    3. Eardley, Anne & Elkind, Andrea Knopf & Spencer, Brenda & Hobbs, Patricia & Pendleton, Laura L. & Haran, Dave, 1985. "Attendance for cervical screening--Whose problem?," Social Science & Medicine, Elsevier, vol. 20(9), pages 955-962, January.
    4. 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.
    5. 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.
    6. Haynes, Robin, 1991. "Inequalities in health and health service use: Evidence from the general household survey," Social Science & Medicine, Elsevier, vol. 33(4), pages 361-368, January.
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    Cited by:

    1. Maria Goddard, 2008. "Quality in and Equality of Access to Healthcare Services in England," Working Papers 040cherp, Centre for Health Economics, University of York.
    2. Shengelia, Bakhuti & Tandon, Ajay & Adams, Orvill B. & Murray, Christopher J.L., 2005. "Access, utilization, quality, and effective coverage: An integrated conceptual framework and measurement strategy," Social Science & Medicine, Elsevier, vol. 61(1), pages 97-109, July.
    3. repec:spr:eujhec:v:19:y:2018:i:3:d:10.1007_s10198-017-0895-5 is not listed on IDEAS
    4. Katharina Hauck & Rebecca Shaw & Peter C. Smith, 2002. "Reducing avoidable inequalities in health: a new criterion for setting health care capitation payments," Health Economics, John Wiley & Sons, Ltd., vol. 11(8), pages 667-677.
    5. Brian Ferguson, 1998. "Shaping up to improve health: the strategic leadership role of the new Health Authority," Working Papers 162chedp, Centre for Health Economics, University of York.
    6. Propper, Carol, 2000. "The demand for private health care in the UK," Journal of Health Economics, Elsevier, vol. 19(6), pages 855-876, November.
    7. Alice sanwald & Engelbert Theurl, 2014. "What drives out-of pocket health expenditures of private households? - Empirical evidence from the Austrian household budget survey," Working Papers 2014-04, Faculty of Economics and Statistics, University of Innsbruck.
    8. Marty Makinen & Stephanie Sealy & Ricardo A. Bitrán & Sam Adjei & Rodrigo Muñoz, 2011. "Private Health Sector Assessment in Ghana," World Bank Publications, The World Bank, number 5956, December.

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    inequity; socio-economics; demography;


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