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

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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.
Original languageEnglish
Pages (from-to)290-314
Number of pages25
JournalJournal of Health Economics
Early online date23 Jun 2017
Publication statusPublished - Jan 2018

Bibliographical note

© 2017, The Authors.


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

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