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

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 most socioeconomically advantaged patients at all quantiles of the waiting time distribution. These patients also benefit from variation in supply endowments. These results challenge the universal health system's core principle of equitable treatment.

Waiting time prioritisation: Evidence from England

“…Similarly, Monstad et al (2014) find that in Norway richer men and more educated women tend to wait less for hip replacement; see also Kaarboe and Carlsen (2014). Similar evidence for Australia is provided by Sharma et al (2013) and Johar et al (2013). There are also a number of empirical studies that estimate the effect of longer waiting time on pre-and post-operative patient health.…”

Economic Incentives in Health Care: The Case of Assigning Patients as “Not Ready for Care”

“…Comparing the NRFC and the non‐NRFC cases, the NRFC cases are slightly older, a greater proportion lives outside of the major city, more are retired, in the lowest income bracket, and have no private health insurance. The relatively low private health insurance rate in this sample compared to that of the general population can be explained by the public hospitals setting (Johar et al ., ,b). In private hospitals, there is effectively no waiting list since patients arrange their timing with their treating specialist privately.…”

“…Using variation in local area's socioeconomic status, Johar et al . (,b) find that the most socioeconomically advantaged patients are always prioritised by specialists, regardless of their medical urgency. Similarly, comparing among patients waiting for the same procedure, Johar and Savage () find that private patients in public hospitals who are paying for their care have much shorter waiting times than public patients who are non‐paying patients.…”

“…In this paper, we assess this issue using data from Australia, where the use of performance targets has only been recently adopted, and to a much lesser extent than which applies in Britain. Specialist incentives for payment may also lead to the promotion of specific types of patients and, there has been evidence of asymmetry in access to health care in Australia according to patient economic status (Johar & Savage, 2010;Johar et al, 2013a). *This research is funded by ARC project grant DE140100719.…”

Gender bias in public long-term care? A survey experiment among care managers

“…Several recent studies examine the relationship between waiting times and socioeconomic status (Carlsen and Kaarbøe, 2012;Kaarbøe and Carlsen, 2014;Johar et al, 2013;Siciliani and Verzulli, 2009). All of these studies find higher income and education to be associated with lower waiting times for public health services.…”