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Discrimination in a universal health system: Explaining socioeconomic waiting time gaps

Author

Listed:
  • Meliyanni Johar

    (Economics Discipline Group, University of Technology, Sydney)

  • Glenn Jones

    (Economics Discipline Group, University of Technology, Sydney)

  • Michael P. Keane

    (Nuffield College, University of Oxford)

  • Elizabeth Savage

    (Economics Discipline Group, University of Technology, Sydney)

  • Olena Stavrunova

    (Economics Discipline Group, University of Technology, Sydney)

Abstract

One of the core goals of a universal health care system is to eliminate discrimi- nation on the basis of socioeconomic status. We test for discrimination using patient waiting times for non-emergency treatment in public hospitals. Waiting time should re ect patients' clinical need with priority given to more urgent cases. Using data from Australia, we nd evidence of prioritisation of the most socioeconomically advantaged patients at all quantiles of the waiting time distribution. These patients also bene t from variation in supply endowments. These results challenge the universal health system's core principle of equitable treatment.

Suggested Citation

  • Meliyanni Johar & Glenn Jones & Michael P. Keane & Elizabeth Savage & Olena Stavrunova, 2012. "Discrimination in a universal health system: Explaining socioeconomic waiting time gaps," Economics Papers 2012-W11, Economics Group, Nuffield College, University of Oxford.
  • Handle: RePEc:nuf:econwp:1211
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    References listed on IDEAS

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    Cited by:

    1. 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.
    2. Laia Bosque‐Mercader & Neus Carrilero & Anna García‐Altés & Guillem López‐Casasnovas & Luigi Siciliani, 2023. "Socioeconomic inequalities in waiting times for planned and cancer surgery: Evidence from Spain," Health Economics, John Wiley & Sons, Ltd., vol. 32(5), pages 1181-1201, May.
    3. MAZEIKAITE Gintare & O'DONOGHUE Cathal & SOLOGON Denisa, 2017. "Decomposing health inequality in the EU," LISER Working Paper Series 2017-02, Luxembourg Institute of Socio-Economic Research (LISER).
    4. Gintare Mazeikaite & Cathal O’Donoghue & Denisa M. Sologon, 2019. "The Great Recession, financial strain and self-assessed health in Ireland," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(4), pages 579-596, June.
    5. Andrew M. Jones & Roberto Zanola, 2015. "Does the law of one price hold in non-standard investment markets? Why selling picasso in New York is differents," ACEI Working Paper Series AWP-04-2015, Association for Cultural Economics International, revised May 2015.
    6. Pulok, Mohammad Habibullah & van Gool, Kees & Hall, Jane, 2020. "Horizontal inequity in the utilisation of healthcare services in Australia," Health Policy, Elsevier, vol. 124(11), pages 1263-1271.
    7. Awaworyi Churchill, Sefa & Ocloo, Janet Exornam & Siawor-Robertson, Diana, 2015. "Ethnic diversity makes me sick! An examination of ethnic diversity’s effect on health outcomes," EconStor Preprints 123721, ZBW - Leibniz Information Centre for Economics.
    8. Jakobsson, Niklas & Kotsadam, Andreas & Syse, Astri & Øien, Henning, 2016. "Gender bias in public long-term care? A survey experiment among care managers," Journal of Economic Behavior & Organization, Elsevier, vol. 131(PB), pages 126-138.
    9. Breton, Mylaine & Smithman, Mélanie Ann & Sasseville, Martin & Kreindler, Sara A. & Sutherland, Jason M. & Beauséjour, Marie & Green, Michael & Marshall, Emily Gard & Jbilou, Jalila & Shaw, Jay & Brou, 2020. "How the design and implementation of centralized waiting lists influence their use and effect on access to healthcare - A realist review," Health Policy, Elsevier, vol. 124(8), pages 787-795.
    10. 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.
    11. Carlsen, Fredrik & Kaarboe, Oddvar Martin, 2015. "The relationship between educational attainment and waiting time among the elderly in Norway," Health Policy, Elsevier, vol. 119(11), pages 1450-1458.
    12. 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.
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    15. 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.
    16. 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.
    17. Sefa Awaworyi Churchill & Janet Exornam Ocloo & Diana Siawor-Robertson, 2017. "Ethnic Diversity and Health Outcomes," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 134(3), pages 1077-1112, December.
    18. 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).
    19. Mohammad Hajizadeh, 2018. "Does socioeconomic status affect lengthy wait time in Canada? Evidence from Canadian Community Health Surveys," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(3), pages 369-383, April.
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    21. Meliyanni Johar, 2014. "Are Waiting List Prioritization Guidelines Being Followed in Australia?," Medical Decision Making, , vol. 34(8), pages 976-986, November.
    22. Gintare Mazeikaite & Cathal O’Donoghue & Denisa M. Sologon, 2021. "What Drives Cross-Country Health Inequality in the EU? Unpacking the Role of Socio-economic Factors," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 155(1), pages 117-155, May.

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    More about this item

    Keywords

    Public hospital; waiting time; discrimination; decomposition analysis;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • J7 - Labor and Demographic Economics - - Labor Discrimination
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • C14 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Semiparametric and Nonparametric Methods: General
    • C21 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Cross-Sectional Models; Spatial Models; Treatment Effect Models

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