How a universal health system reduces inequalities: Lessons from England

Asaria, Miqdad, Ali, Shehzad, Doran, Tim, Ferguson, Brian, Fleetcroft, Robert, Goddard, Maria, Goldblatt, Peter, Laudicella, Mauro, Raine, Rosalind and Cookson, Richard (2016) How a universal health system reduces inequalities: Lessons from England. Journal of Epidemiology and Community Health, 70 (7). pp. 637-643. ISSN 0143-005X

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Background: Provision of universal coverage is essential for achieving equity in healthcare, but inequalities still exist in universal healthcare systems. Between 2004/5 and 2011/12 the English NHS, which has provided universal coverage since 1948, made sustained efforts to reduce health inequalities by strengthening primary care. We provide the first comprehensive assessment of trends in socioeconomic inequalities of primary care access, quality and outcomes during this period. Methods: Whole-population small area longitudinal study, based on 32,482 neighbourhoods of approximately 1,500 people in England from 2004/5 to 2011/12. We measured slope indices of inequality in four indicators: (i) patients per family doctor (ii) primary care quality (iii) preventable emergency hospital admissions and (iv) mortality from conditions considered amenable to healthcare. Results: Between 2004/5 and 2011/12 there were larger absolute improvements on all indicators in more deprived neighbourhoods. The modelled gap between the most and least deprived neighbourhoods in England decreased by: 193 patients per family doctor (95% confidence interval 173 to 213), 3.29 percentage points of primary care quality (3.13 to 3.45), 0.42 preventable hospitalisations per 1,000 people (0.29 to 0.55) and 0.23 amenable deaths per 1,000 people (0.15 to 0.31). By 2011/12 inequalities in primary care supply and quality were almost eliminated but socio-economic inequality was still associated with 158,396 preventable hospitalisations and 37,983 deaths amenable to healthcare. Conclusions: Between 2004/5 and 2011/12 the NHS succeeded in substantially reducing socioeconomic inequalities in primary care access and quality but made only modest reductions in healthcare outcome inequalities.

Item Type: Article
Additional Information: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:
Uncontrolled Keywords: health inequalities,primary care,access to health care,quality of health care,health outcomes,sdg 10 - reduced inequalities ,/dk/atira/pure/sustainabledevelopmentgoals/reduced_inequalities
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023)
Depositing User: Pure Connector
Date Deposited: 19 Jan 2016 16:00
Last Modified: 04 May 2023 21:31
DOI: 10.1136/jech-2015-206742


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