Waiting times and socioeconomic status: Evidence from England

Abstract

This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link ABSTRACTWaiting times for elective surgery are often referred to as an equitable rationing mechanism in publicly-funded healthcare systems providing access to care not on the basis on willingness to pay or socioeconomic status. This study uses patient level administrative data from the Hospital Episode Statistics database in England to investigate whether patients with higher socioeconomic status (as measured by small area level income and education deprivation) wait less than other patients. The analysis focuses on the time waited for an elective hip replacement in 2001. Overall, it provides evidence of inequity in waiting times favouring more educated individuals and, to a lesser extent, richer individuals. The results from log-linear regression models and duration analysis bring evidence that inequalities occur within hospital providers and over large part of the waiting time distribution. Controlling for hospital heterogeneity reduces bias in the measurement of inequality experienced by the lowest income groups.

Does hospital competition harm equity? Evidence from the English National Health Service

“…This in turn would result in a larger volume of services being allocated to such patients every year as compared with socioeconomically disadvantaged patients who face higher costs in exercising choice and hence are more likely to stay on the waiting list of their local hospital provider. In contrast, advocates of reform claim that this sort of two tier system was already in place before the introduction of competition, with socioeconomically advantaged individuals travelling longer distances (Propper et al 2007) in order to obtain their treatment in hospitals with shorter waiting times (Laudicella et al 2012, Cooper et al 2009. The introduction of choice and competition would then benefit socioeconomically disadvantaged patients by making it easier for them to choose hospitals with shorter waiting times (Dixon and Le Grand, 2006).…”

Spanish public hospital waiting lists: a theoretical and empirical approach

“…Concretely, if GDP were increased by 1%, the waiting list would decrease byapproximately 0.91%, ceteris paribus. Although several authors have found a positive relationship between income and waiting times (Laudicella et al, 2012 or Siciliani andVerzulli, 2009), these results may indicate a positive relationship between more income and better health which has been amply discussed in the literature. For example, Marmot et al (1978), Lantz et al (2007), Lantz and Pritchard (2010), Lee et al (1995), Rose (2001), Case and Deaton (2005), Galama and Kipperluis (2015) amongst others, find that income and social class are, in general, good predictors of morbidity and mortality given that lower social classes tend to lead less healthy lifestyles with worse behaviours than superior social classes.…”

Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level

“…99,100 However, there is evidence to suggest that there remains significant socioeconomic inequalities in waiting time. For instance, Laudicella et al 101 found that elective hip replacement patients in the poorest two socioeconomic quintiles wait about 7% longer than patients in the least deprived quintile across England. In another study, Moscelli et al…”