TY - UNPB
T1 - Socioeconomic inequalities in health care in England
AU - Cookson, Richard Andrew
AU - Propper, Carol
AU - Asaria, Miqdad
AU - Raine, Rosalind
PY - 2016/4
Y1 - 2016/4
N2 - 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, 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).
AB - 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, 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).
KW - Health care
KW - Inequalities
KW - Socioeconomic Factors
M3 - Discussion paper
T3 - CHE Research Paper
SP - 1
EP - 34
BT - Socioeconomic inequalities in health care in England
PB - Centre for Health Economics, University of York
CY - York, UK
ER -