The inverse care law re-examined: a global perspective

Abstract

An inverse care law persists in almost all low-income and middle-income countries, whereby socially disadvantaged people receive less, and lower-quality, health care despite having greater need. By contrast, a disproportionate care law persists in high-income countries, whereby socially disadvantaged people receive more health care, but of worse quality and insufficient quantity to meet their additional needs. Both laws are caused not only by financial barriers and fragmented health insurance systems but also by social inequalities in care seeking and co-investment as well as the costs and benefits of health care. Investing in more integrated universal health coverage and stronger primary care, delivered in proportion to need, can improve population health and reduce health inequality. However, trade-offs sometimes exist between health policy objectives. Health-care technologies, policies, and resourcing should be subjected to distributional analysis of their equity impacts, to ensure the health inequality reduction objective is kept in sight.

The incidence of psoriasis in Chile: an analysis of the National Waiting List Repository

“…One of the main limitations of this study relates to the data‐generating process. We believe that the psoriasis incidence rates estimated using this repository demonstrate a phenomenon known as the inverse care law 12 . This is a public health problem, and means that even though the most deprived populations have greater health problems (both in severity and frequency), they usually receive less care in comparison with wealthier populations.…”

“…We believe that the psoriasis incidence rates estimated using this repository demonstrate a phenomenon known as the inverse care law. 12 This is a public health problem, and means that even though the most deprived populations have greater health problems (both in severity and frequency), they usually receive less care in comparison with wealthier populations. Although it is stipulated in Chile’s professional regulations that all cases of psoriasis should be referred, 5 it seems unlikely that this actually happens.…”

Why the Gap in Evaluating the Social Constructs and the Value of Medicines?

“…Social stressors can ‘get under the skin’ [ 20 , 21 ] such that observed health is lower than it would have been without the social stressors. Faced with these social stressors prior to the availability of a new treatment, the individual may not be well positioned to fully benefit from the new intervention [ 30 ].…”

“…These examples illustrate the conceptual challenge to need measurement discussed in Cookson et al, i.e., the divergence between the observed level of need and the ideal counterfactual level that would exist in the absence of social or structural barriers [ 31 ]. When considered within the context of these scenarios, the disproportionate care law described by Cookson et al, whereby the availability of healthcare is inversely related to the need in the subgroup, takes on greater significance.…”

The Structural Characteristics of Economic Network and Efficiency of Health Care in China

“…The unbalanced development of the regional economy of China actuates the “inverse care law” of medical and health services, which is mainly manifested as the relatively small distribution of medical resources in poor areas and poor geographical accessibility of medical services owing to the large urban-rural and regional differences. There is an inverse correlation between quality medical and health services and the health needs of people, indicating that people in poor areas have higher health needs ( 4 ). Therefore, it is of vital importance to rationally allocate national medical resources according to the economic connections between provinces, and to improve the quality and efficiency of health care in underdeveloped areas to meet the health needs to the maximum extent.…”