Is the British National Health Service equitable? The evidence on socioeconomic differences in utilization

Dixon, Anna; Grand, Julian Le; Henderson, John M.; Murray, Richard; Poteliakhoff, Emmi

doi:10.1258/135581907780279549

Cited by 88 publications

(88 citation statements)

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“…Detailed local monitoring of the unequal impact of out-of-pocket health-care costs on household finances can be considered less important in England, which regularly tops international league tables of fairness in health-care financing and has succeeded in virtually eliminating the threat of catastrophic health-care costs: relatively few people in England report financial difficulties in paying health-care bills or face catastrophic medical expenditures. 19,20 The fact that social inequalities in health-care access and outcomes persist in universal health-care systems has been known for some time, [21][22][23][24] and the findings of our study provide further evidence. Furthermore, there is a risk that some of these inequalities could potentially worsen in future decades as universal healthcare systems come under increasing financial strain even in high-income countries.…”

Section: Background On Equity In Health Caresupporting

confidence: 59%

Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level

Cookson

Asaria

Ali

et al. 2016

Health Serv Deliv Res

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Background: Inequalities in health-care access and outcomes raise concerns about quality of care and justice, and the NHS has a statutory duty to consider reducing them. Objectives: The objectives were to (1) develop indicators of socioeconomic inequality in health-care access and outcomes at different stages of the patient pathway; (2) develop methods for monitoring local NHS equity performance in tackling socioeconomic health-care inequalities; (3) track the evolution of socioeconomic health-care inequalities in the 2000s; and (4) develop ‘equity dashboards’ for communicating equity findings to decision-makers in a clear and concise format. Design: Longitudinal whole-population study at the small-area level. Setting: England from 2001/2 to 2011/12. Participants: A total of 32,482 small-area neighbourhoods (lower-layer super output areas) of approximately 1500 people. Main outcome measures: Slope index of inequality gaps between the most and least deprived neighbourhoods in England, adjusted for need or risk, for (1) patients per family doctor, (2) primary care quality, (3) inpatient hospital waiting time, (4) emergency hospitalisation for chronic ambulatory care-sensitive conditions, (5) repeat emergency hospitalisation in the same year, (6) dying in hospital, (7) mortality amenable to health care and (8) overall mortality. Data sources: Practice-level workforce data from the general practice census (indicator 1), practice-level Quality and Outcomes Framework data (indicator 2), inpatient hospital data from Hospital Episode Statistics (indicators 3–6) and mortality data from the Office for National Statistics (indicators 6–8). Results: Between 2004/5 and 2011/12, more deprived neighbourhoods gained larger absolute improvements on all indicators except waiting time, repeat hospitalisation and dying in hospital. In 2011/12, there was little measurable inequality in primary care supply and quality, but inequality was associated with 171,119 preventable hospitalisations and 41,123 deaths amenable to health care. In 2011/12, > 20% of Clinical Commissioning Groups performed statistically significantly better or worse than the England equity benchmark. Limitations: General practitioner supply is a limited measure of primary care access, need in deprived neighbourhoods may be underestimated because of a lack of data on multimorbidity, and the quality and outcomes indicators capture only one aspect of primary care quality. Health-care outcomes are adjusted for age and sex but not for other risk factors that contribute to unequal health-care outcomes and may be outside the control of the NHS, so they overestimate the extent of inequality for which the NHS can reasonably be held responsible. Conclusions: NHS actions can have a measurable impact on socioeconomic inequality in both health-care access and outcomes. Reducing inequality in health-care outcomes is more challenging than reducing inequality of access to health care. Local health-care equity monitoring against a national benchmark can be performed using any admini...

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Section: Background On Equity In Health Caresupporting

confidence: 59%

Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level

Cookson

Asaria

Ali

et al. 2016

Health Serv Deliv Res

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“…Evidence of socio-economic inequity in the utilisation of non-emergency specialist care relative to need has been found even in high income countries with universal and comprehensive health programmes like the English National Health Service (NHS) [3][4][5]. This is often interpreted as an important indicator of broader socio-economic inequity of access to health care, since utilisation of non-emergency specialist care is potentially sensitive to all of the important financial and non-financial access barriers that people may face in navigating their way through the health system.…”

Section: What This Study Addsmentioning

confidence: 99%

“…This claim was supported by Julian Le Grand, Tony Blair's senior policy adviser from 2003-5, who highlighted evidence that socio-economic inequities in specialist care existed prior to the reforms [3,14]. In contrast, critics argued that the new emphasis on choice, competition and independent sector provision of publicly funded hospital care would undermine socio-economic equity [15][16][17][18].…”

Section: What This Study Addsmentioning

confidence: 99%

Measuring change in health care equity using small-area administrative data – Evidence from the English NHS 2001–2008

Cookson

Laudicella

Donni

2012

Social Science & Medicine

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“…2 Although people from such groups attend primary care more frequently than those from more advantaged socioeconomic groups 3 (which accords with their greater need for care) they are less likely to use preventative 4 and specialist 5,6 health services. This observation, that those in most need of health care are often the least well served in terms of receipt of such care, has been termed the 'inverse care law.…”

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confidence: 99%

Do general practices provide equitable access to physical activity interventions?

Sowden¹,

Breeze²,

Barber³

et al. 2008

Br J Gen Pract

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Exercise referral schemes are widespread across England. National guidance emphasises the need to engage groups that are disadvantaged. AimTo examine the influence of socioeconomic deprivation on referral to, and use of, exercise referral schemes. Design of studyCross-sectional analysis of patients referred by general practices to exercise referral schemes between 2004 and 2006. SettingSix primary care trusts (PCTs) in Greater London. MethodRoutine data about patients who had been referred to exercise referral schemes were used to estimate risk ratios for referral by general practice deprivation quintile, odds ratios (ORs) for uptake, and ORs for completion of exercise referral schemes by patients' deprivation status quintile. ResultsAll 317 general practices in the six PCTs were included in the referral analysis. Referrals were less likely from general practices serving advantaged socioeconomic areas (adjusted risk ratio for trend across deprivation quintiles 0.84; 95% confidence interval [CI] = 0.76 to 0.93). This study found no association between patients' deprivation status and their likelihood of taking up (adjusted OR, least versus most deprived quintile 1.05; 95% CI = 0.83 to 1.33) or completing the scheme (adjusted OR 1.23; 95% CI = 0.84 to 1.79). ConclusionGeneral practices within areas of deprivation were more likely to refer patients to exercise referral schemes than practices in more advantaged areas. Once referred, it was found that patients living in areas of deprivation were as likely to take up and to complete the scheme as those living in more advantaged locations. Research is needed to identify the organisational and contextual factors that allow this pattern of service delivery, which appears to facilitate access to care among patients who live in areas of deprivation. Keywordsexercise; family practice; health promotion; healthcare disparities; referral and consultation; socioeconomic factors. INTRODUCTIONExercise referral schemes are one of the most widely established primary care physical activity interventions in England (Box 1). 1 The majority of referrals to these schemes are made by general practices. 2National guidance emphasises the importance of ensuring that exercise referral schemes are delivered equitably and explicitly states that they should employ strategies to target and engage people from disadvantaged groups.2 Although people from such groups attend primary care more frequently than those from more advantaged socioeconomic groups 3 (which accords with their greater need for care) they are less likely to use preventative 4 and specialist 5,6 health services. This observation, that those in most need of health care are often the least well served in terms of receipt of such care, has been termed the 'inverse care law.' 7The benefits of physical activity for the primary and secondary prevention of a range of clinical conditions 8 underpin the eligibility criteria for exercise referral schemes.2 It is likely that there is higher eligibility for these schemes among patients from ...

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Is the British National Health Service equitable? The evidence on socioeconomic differences in utilization

Cited by 88 publications

References 0 publications

Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level

Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level

Measuring change in health care equity using small-area administrative data – Evidence from the English NHS 2001–2008

Do general practices provide equitable access to physical activity interventions?

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