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Socioeconomic inequalities in health care in England

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Title: Socioeconomic inequalities in health care in England
Authors: Cookson, R
Propper, C
Asaria, M
Raine, R
Item 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).
Issue Date: 21-Nov-2016
Date of Acceptance: 23-Mar-2016
URI: http://hdl.handle.net/10044/1/31837
DOI: https://dx.doi.org/10.1111/j.1475-5890.2016.12109
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.
Sponsor/Funder: Economic & Social Research Council (ESRC)
Funder's Grant Number: ES/J023108/1
Keywords: 1402 Applied Economics
Publication Status: Published
Appears in Collections:Imperial College Business School