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Who uses the NHS more - the poor or the rich?

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Poorer people make less use of NHS services than middle income or richer people given their respective needs for health care, a study by LSE academics and Department of Health staff has revealed today [Friday 7 November].

Anna Dixon and Julian Le Grand of LSE's Social Policy Department and Richard Murray, John Henderson and Emmi Poteliakhoff of the Department of Health's Economics and Operational Research Unit looked into whether the NHS was equitable - that is, whether some social groups used the NHS more than others according to their need.

In their report Is the NHS equitable? they review what is meant by equitable access, what form inequity takes and what are its principal causes. They concluded that:

  • Deprived individuals and families use the health service less than their levels of need would indicate they should.
  • There are inequities in gaining access to a range of NHS services including cardiac, diagnostic and surgical care, elective procedures for hernia, gallstones, tonsillitis, hip replacements, and grommets, inpatient oral surgery, immunisation for diphtheria, pertussis, measles, mumps and rubella, and diabetes clinics and diabetes reviews.
  • For example, a study in Yorkshire found that although lower socio-economic groups have a roughly 30 per cent higher need for a hip replacement, the operation rate was 20 per cent lower compared to higher socio-economic groups. National data for England and Wales shows that people from social classes IV and V aged 16-44 years old have fewer consultations for preventive health care - 10 per cent fewer compared with people from social classes I and II.
  • Why is getting health care easier for some rather than others? There are many factors, some relate to the problems of making first contact with the service, others concern the problems people experience once contact has been established.
  • Some of the reasons why different socio-economic groups have different access to health services include longer travel time, greater travel cost and lower car ownership (though not distance). Another factor could be that people in different groups have to make different time trade offs of attending for health care, while the confidence and ability to articulate among the middle classes - their voice - and their ability to express it - and their networks - are key factors affecting their ability to communicate with GPs and to promote referral onwards to secondary and tertiary care.
  • Finally, the interaction of health beliefs and health literacy skills are likely to be important in affecting the failure of the service to meet the needs of poorer patients.

Professor Le Grand said: 'The government is currently consulting the public on how choice might improve the responsiveness of the NHS whilst promoting equity. We wanted to know the extent of existing inequities in the NHS and their causes, in order to inform the public debate. From this study, we found there is strong evidence that, in relation to need, lower socio-economic groups use a range of services less than higher groups.

'Why could this be? We still found potential barriers to NHS services for poorer people such as lack of suitable transport and restrictions on time, a difference in beliefs about severity of illness and the need to seek medical attention, and a lack of connections and communications which middle class patients often have. Government and health managers need to be aware of these barriers when designing policies and trying to address inequity.'


Contact: Anna Dixon, LSE and on secondment with the Strategy Unit, Department of Health, tel: 020 7210 5673 or 077210 81150, anna.dixon@doh.gsi.gov.uk| or a.dixon@lse.ac.uk|

Julian Le Grand, LSE and on secondment with the Policy Directorate No. 10 Downing St. Tel: 020 7955 7353. j.legrand@lse.ac.uk|


To read Is the NHS equitable? click here|

Alternatively hard copies of the report can be purchased from Champa Heidbrink, managing editor, LSE Health and Social Care, LSE, Houghton Street, London WC2 2AE. Email. C.Heidbrink@lse.ac.uk| or Waterstone's Economists' Bookshop, based at LSE on Portugal Street. Price £7.50

Press cuttings

Guardian (7 November)
Rich parents get better NHS care
Middle-class people benefit more from the NHS than the poor, according to a report today from senior government advisers that overturns the long-standing boast of ministers that the health service's greatest virtue was fairness to all-comers.

Independent (8 November)
NHS is failing the poor, Reid admits
The NHS has failed to provide equal care to rich and poor, John Reid admitted yesterday. The Secretary of State for Health said the service had to be reformed after academics from the London School of Economics found low-income families experienced disadvantages in accessing health care available to the better-off. 
7 November 2003