Radical solutions needed to address health inequalities

March 07, 2002

New research shows that radical solutions are needed to address health inequalities in the NHS. Interest in the use of direct needs-based methods to allocate health care resources has been growing particularly with the recent release of a report to the Welsh Assembly. It suggested that a 'direct' morbidity-based approach to geographical resource allocation would promote more equal access to healthcare services amongst most vulnerable groups, particularly the poor. 'In fact, because many affluent areas have older population profiles and their overall disease burdens are consequently higher, the results of our study suggest that this approach would result in a shift in resources towards areas serving less deprived populations' explains Dr Sheena Asthana co author of the research.

The ESRC-funded research also shows that rural areas in particular would gain from the introduction of a morbidity-based approach and highlights the need for more clarity about the purpose of resource allocation. 'Targeting more hospital services at the most deprived areas may not be the best way to address health inequalities' explains Dr Asthana. 'In addition to effectively robbing Peter to pay Paul, this ignores the fact that many of the factors which give rise to health inequalities lie outside the control of the NHS. We need a radical rethink of how we allocate resources' she says. 'If the Government is serious about eliminating health inequalities, it will need to demonstrate a real political commitment to supporting public health programmes and broader social policy interventions' she adds.

The research undertaken by a team at Plymouth, Exeter and Portsmouth Universities also looked at variations in rates of health service use according to need. The findings of the research challenge the perceived wisdom that the use of NHS services is characterised by inverse care where those who get a raw deal in hospital care tend to be from the poorest sections of society. 'For example, practices which serve deprived populations are found to use in-patient cardiology services to a significantly higher level than expected' says Dr Asthana. 'Age and sex also emerge as significant determinants of service access with rates of hospital intervention falling off progressively with age and with men more likely to receive treatment than women in all categories of care' she adds.

'The assumption that higher rates of hospital care are necessarily a 'good thing' should be revisited. Within an urban setting, the pro-poor bias in levels of hospitalisation may reflect poorer primary and community management suggesting a need for a stronger public health focus' says Dr Asthana. 'Differences in treatment according to age and sex should also be investigated further to ensure that such differences are clinically justified. To this end more robust approaches to monitoring fair access is needed' she adds. '

Economic & Social Research Council
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