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Socioeconomic inequality of access to healthcare: Does choice explain the gradient?

Giuseppe Moscelli (), Luigi Siciliani (), Nils Gutacker () and Richard Cookson

Journal of Health Economics, 2018, vol. 57, issue C, 290-314

Abstract: 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.

Keywords: Waiting times; Inequalities; Socioeconomic status; Selection bias; Choice (search for similar items in EconPapers)
JEL-codes: I14 I11 I18 C34 (search for similar items in EconPapers)
Date: 2018
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