Vertical and horizontal aspects of socio‐economic inequity in general practitioner contacts in Scotland

Abstract

Health status varies across socio-economic groups and health status is generally assumed to predict health care needs. Therefore the need for health care varies across socio-economic groups, and studies of equity in the distribution of health care between socio-economic groups must compare levels of utilisation with levels of need. Economic studies of equity in health care generally assume that health care needs can be derived from the current health-health care relationship. They therefore do not consider whether the current health-health care relationship is (vertically) equitable and the focus is restricted to horizontal inequity. This paper proposes a framework for incorporating the implications of vertical inequity for the socio-economic distribution of health care. An alternative to the current health-health care relationship is proposed using a restriction on the health-elasticity of health care. The health-elasticity of general practitioner contacts in Scotland is found to be generally negative, but positive at low levels of health status. Pro-rich estimates of horizontal inequity and vertical inequity are obtained but neither is statistically significant. Further analysis demonstrates that the magnitude of vertical inequity in health care may be larger than horizontal inequity.

Did general practice health assessments of older Australians improve equity?

“…28 Horizontal equity refers to equal treatment to equals and vertical equity refers to unequal treat-Rehabilitation, Disability and Ageing ment to unequal need. 28 It was not possible to comment on certain horizontal aspects of equity in this study, as it could only examine differences between groups not within groups.…”

Measurement of inequity in health care with heterogeneous response of use to need

“…The message of the paper is related to, but distinct from, that of Sutton (2002), who argues that even if horizontal equity is satisfied, in the sense of there being no socioeconomic-related variation in utilisation at each level of need, socioeconomic groups in which need is concentrated will still be disadvantaged if there is vertical inequity in the form of higher levels of need not receiving sufficiently greater treatment resources. He identifies the implications for socioeconomic-related inequity of a homogeneous but unfair use-need relationship.…”

“…Sutton (2002) concentrates on vertical inequity -treatment resources do not rise sufficiently with medical need such that those in greater need are not fairly prioritized.…”

Le renforcement de l'interface entre les services de santé publique et de première ligne : enjeux et pistes de solution

“…Les interventions cliniques de prévention et de promotion de la santé réalisées par les médecins, notamment sur les habitudes de vie, sont reconnues efficaces pour la réduction de la mortalité et de la morbidité associées aux maladies chroniques (Helman 1997;Hawk et Lippman 2000;Adami et al 2001;Visscher et Seidell 2001;Rebanal et Leman 2005). De plus, l' apport de la SP dans l' organisation des services permet de réduire les inégalités sociales de santé (Frenk 1993;Lee et Paxman 1997;Roussos et Fawcett 2000;Shi et al 2002;Sutton 2002). Les collaborations prometteuses, surtout entre des partenaires de natures différentes, requièrent généralement une confiance mutuelle et des situations gagnant-gagnant (Lewis 1997).…”