The University of York Centre for Health Economics have published a study providing evidence of income-related inequalities in waiting times for cardiac revascularisation procedures in the English NHS.
Using data on patients undergoing non-emergency heart revascularization procedures, this study found evidence of significant differences in waiting times within public hospitals between patients with different socioeconomic status (up to 35% difference between the most and least deprived population quintiles).
The researchers employed selection models to test whether such differences were explained by patients exercising choice over hospital or type of treatment. They found that selection bias due to choice has a limited effect on the gradient, suggesting the presence of substantial inequities within the public system.
The authors suggest several mechanisms may explain the presence of a gradient in waiting times. These include ‘elbowing behaviour’ – where more socioeconomically advantaged patients are likely better endowed with information, networking skills, contacts and consciousness of their rights, enabling them to exercise more effective pressure to get prioritised for treatment.
They recommend future research could explore in greater detail which of the mechanisms suggested in the paper is at work.
The gap was also found to be large compared to the gradient identified in other studies for non-life-threatening treatments such as hip replacements. The authors conclude that this suggests inequalities in waiting times may be exacerbated when patients seek care for potentially life-threatening diseases.
The authors conclude that publicly-funded health systems are prone to substantial pro-rich inequalities in hospital waiting times, even in countries like England with well-funded and mature systems of universal health coverage. Their research has shown that substantial socioeconomic inequalities can occur within the same hospital, for patients waiting for effective treatment for a serious heart condition, and that these inequalities are not primarily due to differences in patient choice of hospital or procedure.
The full study can be read here.
Socioeconomic inequality of access to healthcare: Does patients’ choice explain the gradient? Evidence from the English NHS
Giuseppe Moscelli, Luigi Siciliani, Nils Gutacker, Richard Cookson
Centre for Health Economics, University of York