Equity in health care after 10 years of the New Rural Co-operative Medical Insurance Scheme in China: an analysis of national survey data

The central objectives of the ‘Blair/Brown’ reforms of the English NHS in the 2000s were to reduce hospital waiting times and improve the quality of care. However, critics raised concerns that the choice and competition elements of reform might undermine socioeconomic equity in health care. By contrast, the architects of reform predicted that accelerated growth in NHS spending combined with increased patient choice of hospital would enhance equity for poorer patients. This paper draws together and discusses the findings of three large-scale national studies designed to shed empirical light on this issue. Study one developed methods for monitoring change in neighbourhood level socioeconomic equity in the utilization of health care, and found no substantial change in equity between 2001-02 and 2008-09 for non-emergency hospital admissions, outpatient admissions (from 2004-05) and a basket of specific hospital procedures (hip replacement, senile cataract, gastroscopy and coronary revascularization). Study two found that increased competition between 2003-04 and 2008-09 had no substantial effect on socioeconomic equity in health care. Study three found that potential incentives for public hospitals to select against socioeconomically-disadvantaged hip replacement patients were small, compared with incentives to select against elderly and co-morbid patients. Taken together, these findings suggest that the Blair/Brown reforms had little effect on socioeconomic equity in health care. This may be because the ‘dose’ of competition was small and most hospital services continued to be provided by public hospitals which did not face strong incentives to select against socioeconomically-disadvantaged patients.

Download Full-text

Comparing Critical Realism and the Situated Knowledges Approach in Research on (In)equity in Health Care: An Exploration of their Implications

Gender, Feminism and Critical Realism ◽

10.4324/9780203732403-4 ◽

2018 ◽

pp. 44-61

Author(s):

Goldina Smirthwaite ◽

Katarina Swahnberg

Keyword(s):

Health Care ◽

Critical Realism ◽

Equity In Health ◽

Situated Knowledges ◽

Equity In Health Care

Download Full-text

2.10-P4Networks as a tool for improving migrant health and equity in health care in Norway

European Journal of Public Health ◽

10.1093/eurpub/cky048.055 ◽

2018 ◽

Vol 28 (suppl_1) ◽

Author(s):

R Spilker

Keyword(s):

Health Care ◽

Migrant Health ◽

Equity In Health ◽

Equity In Health Care

Download Full-text

Intersectional equity in health care: assessing complex inequities in primary and secondary care utilization by gender and education in northern Sweden

International Journal for Equity in Health ◽

10.1186/s12939-020-01272-7 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Fortune N. Nyamande ◽

Paola A. Mosquera ◽

Miguel San Sebastián ◽

Per E. Gustafsson

Keyword(s):

Primary Care ◽

Health Care ◽

Health Care Utilization ◽

Horizontal Equity ◽

Care Utilization ◽

Northern Sweden ◽

Equity In Health ◽

Percentage Points ◽

Low Educated ◽

Equity In Health Care

Abstract Background Knowledge remains scarce about inequities in health care utilization between groups defined, not only by single, but by multiple and intersecting social categories. This study aims to estimate intersectional horizontal inequities in health care utilization by gender and educational level in Northern Sweden, applying a novel methodological approach. Methods Data on participants (N = 22,997) aged 16–84 years from Northern Sweden came from the 2014 Health on Equal Terms cross sectional survey. Primary (general practitioner) and secondary (specialist doctor) health care utilization and health care needs indicators were self-reported, and sociodemographic information came from registers. Four intersectional categories representing high and low educated men, and high and low educated women, were created, to estimate intersectional (joint, referent, and excess) inequalities, and needs-adjusted horizontal inequities in utilization. Results Joint inequalities in primary care were large; 8.20 percentage points difference (95%CI: 6.40–9.99) higher utilization among low-educated women than high-educated men. Only the gender referent inequity remained after needs adjustment, with high- (but not low-) educated women utilizing care more frequently than high-educated men (3.66 percentage points difference (95%CI: 2.67–5.25)). In contrast, inequalities in specialist visits were dominated by referent educational inequalities, (5.69 percentage points difference (95%CI: 2.56–6.19), but with no significant horizontal inequity – by gender, education, or their combination – remaining after needs adjustment. Conclusion This study suggests a complex interaction of gender and educational inequities in access to care in Northern Sweden, with horizontal equity observable for secondary but not primary care. The study thereby illustrates the unique knowledge gained from an intersectional perspective to equity in health care.

Download Full-text