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The inverse care law re-examined: a global perspective

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JournalThe Lancet
DatePublished - 27 Feb 2021
Issue number10276
Volume397
Number of pages11
Pages (from-to)828-838
Original languageEnglish

Abstract

An inverse care law persists in almost all low-income and middle-income countries, whereby socially disadvantaged people receive less, and lower-quality, health care despite having greater need. By contrast, a disproportionate care law persists in high-income countries, whereby socially disadvantaged people receive more health care, but of worse quality and insufficient quantity to meet their additional needs. Both laws are caused not only by financial barriers and fragmented health insurance systems but also by social inequalities in care seeking and co-investment as well as the costs and benefits of health care. Investing in more integrated universal health coverage and stronger primary care, delivered in proportion to need, can improve population health and reduce health inequality. However, trade-offs sometimes exist between health policy objectives. Health-care technologies, policies, and resourcing should be subjected to distributional analysis of their equity impacts, to ensure the objective of reducing health inequalities is kept in sight.

Bibliographical note

Funding Information:
RC, TD, and FPM are supported by the Wellcome Trust (grant number 205427/Z/16/Z). For helpful comments we would like to thank Mark Ashworth, Rama Baru, Chris Bentley, Callum Brindley, Kevin Fiscella, Robert Fleetcroft, John Ford, Peter Goldblatt, Hugh Gravelle, Davidson Gwatkin, Elaine Kelly, Julian Le Grand, Ajay Mahal, Owen O'Donnell, Trevor Sheldon, Peter Smith, Cesar Victora, Elizabeth Walton, and Margaret Whitehead. Any errors or opinions expressed in this publication are those of the authors and not those of the NHS, Wellcome Trust, or any individuals who provided comment.

Funding Information:
RC, TD, and FPM are supported by the Wellcome Trust (grant number 205427/Z/16/Z). For helpful comments we would like to thank Mark Ashworth, Rama Baru, Chris Bentley, Callum Brindley, Kevin Fiscella, Robert Fleetcroft, John Ford, Peter Goldblatt, Hugh Gravelle, Davidson Gwatkin, Elaine Kelly, Julian Le Grand, Ajay Mahal, Owen O'Donnell, Trevor Sheldon, Peter Smith, Cesar Victora, Elizabeth Walton, and Margaret Whitehead. Any errors or opinions expressed in this publication are those of the authors and not those of the NHS, Wellcome Trust, or any individuals who provided comment.

Publisher Copyright:
© 2021 Elsevier Ltd

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