Socioeconomic inequalities in health care in England
File(s)
Author(s)
Cookson, R
Propper, C
Asaria, M
Raine, R
Type
Journal Article
Abstract
This paper reviews what is known about socioeconomic inequalities in health care in England, with particular attention to inequalities relative to need that may be considered unfair (“inequities”). We call inequalities of 5% or less between most and least deprived socioeconomic quintile groups “slight”; inequalities of 6-15% “moderate”, and inequalities of > 15% “substantial”. Overall public health care expenditure is substantially concentrated on poorer people. At any given age, poorer people are more likely to see their family doctor, have a public outpatient appointment, visit accident and emergency, and stay in hospital for publicly funded inpatient treatment. After allowing for current self-assessed health and morbidity, there is slight pro-rich inequity in combined public and private medical specialist visits but not family doctor visits. There are also slight pro-rich inequities in overall indicators of clinical process quality and patient experience from public health care, substantial pro-rich inequalities in bereaved people’s experiences of health and social care for recently deceased relatives, and mostly slight but occasionally substantial pro-rich inequities in the use of preventive care (e.g. dental checkups, eye tests, screening and vaccination) and a few specific treatments (e.g. hip and knee replacement). Studies of population health care outcomes (e.g. avoidable emergency hospitalisation) find substantial pro-rich inequality after adjusting for age and sex only. These findings are all consistent with a broad economic framework that sees health care as just one input into the production of health over the lifecourse, alongside many other socioeconomically patterned inputs including environmental factors (e.g. living and working conditions), consumption (e.g. diet, smoking), self care (e.g. seeking medical information) and informal care (e.g. support from family and friends).
Date Issued
2016-11-21
Date Acceptance
2016-03-23
Citation
Fiscal Studies, 2016, 37 (3-4), pp.371-403
ISSN
1475-5890
Publisher
Wiley
Start Page
371
End Page
403
Journal / Book Title
Fiscal Studies
Volume
37
Issue
3-4
Copyright Statement
©2016 The Authors. Fiscal Studies published by John Wiley & Sons Ltd. on behalf of Institute for Fiscal Studies.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution
and reproduction in any medium, provided the original work is properly cited.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution
and reproduction in any medium, provided the original work is properly cited.
License URL
Sponsor
Economic & Social Research Council (ESRC)
Grant Number
ES/J023108/1
Subjects
1402 Applied Economics
Economics
Publication Status
Published