Socio‐Economic Inequalities in Health Care in England

Richard Cookson,Carol Propper,Miqdad Asaria,Rosalind Raine

doi:10.1111/j.1475-5890.2016.12109

Richard Cookson, Carol Propper + Show 2 more

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https://doi.org/10.1111/j.1475-5890.2016.12109

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Abstract

AbstractThis paper reviews what is known about socio‐economic 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 per cent or less between the most and least deprived socio‐economic quintile groups ‘slight’, inequalities of 5–15 per cent ‘moderate’ and inequalities of more than 15 per cent ‘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 in 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 (for example, dental check‐ups, eye tests, screening and vaccination) and a few specific treatments (for example, hip and knee replacement). Studies of population health care outcomes (for example, 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 life course, alongside many other socio‐economically patterned inputs including environmental factors (for example, living and working conditions), consumption (for example, diet and smoking), self‐care (for example, seeking medical information) and informal care (for example, support from family and friends).

Highlights

This paper reviews evidence on socio-economic inequalities in health care in England, a country that consistently comes near the top of international league tables of equity in health care financing.1 Benefit incidence studies show that public health care expenditure in England disproportionately benefits poorer people.2 this does not necessarily mean that health care is distributed fairly in relation to need, since poorer people tend to be sicker and so have greater need for health care
All high-income countries offer their citizens a substantial package of publicly-funded health care, including countries with relatively low shares of public expenditure on health such as the US and Chile, which spend just under 50 per cent compared with the OECD average of 73 per cent in 2012.3 While all health care systems in wealthy countries have equity goals relating to access to, and/or delivery of, health care as well as its financing,4 the English National Health Service (NHS) is unusual in having explicit policy objectives relating to reducing inequalities in health care outcomes
Most economic studies focus on the general population and seek to provide a comprehensive picture of health care inequality across the health care sector as a whole

Summary

Introduction

This paper reviews evidence on socio-economic inequalities in health care in England, a country that consistently comes near the top of international league tables of equity in health care financing. Benefit incidence studies show that public health care expenditure in England disproportionately benefits poorer people. this does not necessarily mean that health care is distributed fairly in relation to need, since poorer people tend to be sicker and so have greater need for health care. All high-income countries offer their citizens a substantial package of publicly-funded health care, including countries with relatively low shares of public expenditure on health such as the US and Chile, which spend just under 50 per cent compared with the OECD average of 73 per cent in 2012.3 While all health care systems in wealthy countries have equity goals relating to access to, and/or delivery of, health care as well as its financing, the English NHS is unusual in having explicit policy objectives relating to reducing inequalities in health care outcomes. These objectives were first articulated in 20005 and formalised in the 2012 Health and Social Care Act.

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