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Discrimination in a Universal Health System: Explaining Socioeconomic Waiting Time Gaps

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Abstract

One of the core goals of a universal health care system is to eliminate discrimination on the basis of socioeconomic status. We test for discrimination using patient waiting times for non-emergency treatment in public hospitals. Waiting time should reflect patients clinical need with priority given to more urgent cases. Using data from Australia, we find evidence of prioritisation of the richest patients, especially the least urgent, who can be delayed with lower health risks, thereby allowing more scope for discrimination. The rich also benefit from variation in supply endowments. These results challenge the universal system's core principle of equitable treatment.

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  • Meliyanni Johar & Glenn Jones & Michael Keane & Elizabeth Savage & Olena Stavrunova, 2011. "Discrimination in a Universal Health System: Explaining Socioeconomic Waiting Time Gaps," Working Paper Series 165, Finance Discipline Group, UTS Business School, University of Technology, Sydney.
  • Handle: RePEc:uts:wpaper:165
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    Cited by:

    1. 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.
    2. 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.
    3. Gutacker, Nils & Siciliani, Luigi & Cookson, Richard, 2016. "Waiting time prioritisation: Evidence from England," Social Science & Medicine, Elsevier, vol. 159(C), pages 140-151.
    4. Landi, Stefano & Ivaldi, Enrico & Testi, Angela, 2018. "Socioeconomic status and waiting times for health services: An international literature review and evidence from the Italian National Health System," Health Policy, Elsevier, vol. 122(4), pages 334-351.
    5. MAZEIKAITE Gintare & O'DONOGHUE Cathal & SOLOGON Denisa, 2017. "Decomposing health inequality in the EU," LISER Working Paper Series 2017-02, LISER.
    6. 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.
    7. 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.
    8. 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.
    9. 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.
    10. 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.
    11. 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.
    12. 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.
    13. 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.
    14. Gloria Moroni, 2018. "Explaining Divorce Gaps in Cognitive and Noncognitive Skills of Children," Discussion Papers 18/16, Department of Economics, University of York.
    15. Meliyanni Johar, 2014. "Are Waiting List Prioritization Guidelines Being Followed in Australia?," Medical Decision Making, , vol. 34(8), pages 976-986, November.
    16. 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.
    17. 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.
    18. 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.

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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

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