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Socioeconomic Inequality of Access to Healthcare: Does Choice Explain the Gradient?

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Publication details

JournalJournal of Health Economics
DateAccepted/In press - 11 Jun 2017
DateE-pub ahead of print - 23 Jun 2017
DatePublished (current) - Jan 2018
Number of pages25
Pages (from-to)290-314
Early online date23/06/17
Original languageEnglish


Equity of access is a key policy objective in publicly-funded healthcare systems. However, observed inequalities of access by socioeconomic status may result from differences in patients’ choices. Using data on non-emergency coronary revascularisation procedures in the English National Health Service, we found substantive differences in waiting times within public hospitals between patients with different socioeconomic status: up to 35% difference, or 43 days, between the most and least deprived population quintile groups. Using selection models with differential distances as identification variables, we estimated that only up to 12% of these waiting time inequalities can be attributed to patients’ choices of hospital and type of treatment (heart bypass versus stent). Residual inequality, after allowing for choice, was economically significant: patients in the least deprived quintile group benefited from shorter waiting times and the associated health benefits were worth up to £850 per person.

Bibliographical note

© 2017, The Authors.

    Research areas

  • Choice, Inequalities, Selection bias, Socioeconomic status, Waiting times

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