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Waiting Times and Socioeconomic Status: Evidence from England

  • Laudicella, M.;
  • Siciliani, L.;
  • Cookson, R.;

Waiting times for elective surgery, like hip replacement, are often referred to as an equitable rationing mechanism in publicly-funded healthcare systems because access to care is not based on socioeconomic status. This study uses patient level administrative data from the Hospital Episode Statistics database in England to investigate whether patients with higher socioeconomic status (as measured by small area level income and education deprivation) wait less than other patients. The analysis focuses on the time waited for an elective hip replacement in 2001. Overall, it provides evidence of inequity in waiting times favouring more educated individuals and, to a lesser extent, richer individuals. The results from log-linear regression models and duration analysis bring evidence that inequalities occur within hospitals and over large part of the waiting time distribution. The inequality experienced by the lowest income group increases after controlling for hospital heterogeneity.

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Paper provided by HEDG, c/o Department of Economics, University of York in its series Health, Econometrics and Data Group (HEDG) Working Papers with number 10/05.

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Date of creation: Apr 2010
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Handle: RePEc:yor:hectdg:10/05
Contact details of provider: Postal: HEDG/HERC, Department of Economics and Related Studies, University of York, York, YO10 5DD, United Kingdom
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Web page: http://www.york.ac.uk/economics/postgrad/herc/hedg/
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  1. Ermisch, John F. & Jenkins, Stephen P., 1999. "Retirement and housing adjustment in later life: evidence from the British Household Panel Survey," Labour Economics, Elsevier, vol. 6(2), pages 311-333, June.
  2. Gravelle, Hugh & Siciliani, Luigi, 2008. "Ramsey waits: Allocating public health service resources when there is rationing by waiting," Journal of Health Economics, Elsevier, vol. 27(5), pages 1143-1154, September.
  3. Tom Stargardt, 2008. "Health service costs in Europe: cost and reimbursement of primary hip replacement in nine countries," Health Economics, John Wiley & Sons, Ltd., vol. 17(S1), pages S9-S20.
  4. 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.
  5. Cullis, John G. & Jones, Philip R. & Propper, Carol, 2000. "Waiting lists and medical treatment: Analysis and policies," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 23, pages 1201-1249 Elsevier.
  6. David Briggs & Daniela Fecht & Kees de Hoogh, 2007. "Census data issues for epidemiology and health risk assessment: experiences from the Small Area Health Statistics Unit," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 170(2), pages 355-378.
  7. Sofia Dimakou & David Parkin & Nancy Devlin & John Appleby, 2009. "Identifying the impact of government targets on waiting times in the NHS," Health Care Management Science, Springer, vol. 12(1), pages 1-10, March.
  8. Hamilton, Barton H & Bramley-Harker, Robert Edward, 1999. "The Impact of the NHS Reforms on Queues and Surgical Outcomes in England: Evidence from Hip Fracture Patients," Economic Journal, Royal Economic Society, vol. 109(457), pages 437-62, July.
  9. Martin, Stephen & Smith, Peter C., 1999. "Rationing by waiting lists: an empirical investigation," Journal of Public Economics, Elsevier, vol. 71(1), pages 141-164, January.
  10. Luigi Siciliani & Rossella Verzulli, 2009. "Waiting times and socioeconomic status among elderly Europeans: evidence from SHARE," Health Economics, John Wiley & Sons, Ltd., vol. 18(11), pages 1295-1306.
  11. Hugh Gravelle & Luigi Siciliani, 2008. "Is waiting-time prioritisation welfare improving?," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 167-184.
  12. 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.
  13. Lindsay, Cotton M & Feigenbaum, Bernard, 1984. "Rationing by Waiting Lists," American Economic Review, American Economic Association, vol. 74(3), pages 404-17, June.
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