Waiting Times and Socioeconomic Status. Evidence From Norway

Kaarboe, Oddvar; Carlsen, Fredrik

doi:10.1002/hec.2904

Cited by 35 publications

(30 citation statements)

References 16 publications

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“…6 See, for instance, Cookson et al (2016) for a review of the literature on socio-economic inequalities in healthcare in England, which reveals a large body of research in the fields of health service and social medicine, mainly focusing on small-area (neighbourhood) variations. 7 There are also recent studies on the relationship between SES and waiting times, as a measure of access to health care; see, for example, Kaarboe and Carlsen (2014) and Monstad, Engesaeter, and Espehaug (2014). 8 A similar finding is reported for Norway by Grasdal and Monstad (2011).…”

mentioning

confidence: 58%

“…Individuals can switch GP (at most twice per calender year) within the municipality. 12 The GPs can decide the size of their list, but are required to have at least 500 patients and not more than 2500 patients. If a GP's list is full (closed), then the GP can potentially turn down new patients.…”

Section: Institutional Backgroundmentioning

confidence: 99%

“…5 The key contributions of our paper to the existing literature are the following. First, we use public register data with detailed information about the medical services provided by the 4 There are also recent studies on the relationship between SES and waiting times, as a measure of access to health care; see, e.g., Kaarboe and Carlsen (2014), Monstad et al (2014). 5 There are also some related papers focusing on GPs provision of care to diabetes patients; see Iezzi et al (2014) and Scott et al (2009).…”

Section: Introductionmentioning

confidence: 99%

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Socio‐economic status and physicians' treatment decisions

et al. 2017

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This paper studies the relationship between patients' socio‐economic status and general practitioners' (GPs') service provision by exploiting administrative patient‐level data with information on consultation length, medical tests, and fee payments for each visit in Norway over a 5‐year period (2008–2012). To reduce patient heterogeneity, we limit the sample to a given condition, diabetes type II, that is treated almost exclusively in primary care. We estimate GP fixed‐effect models and control for a wide set of patient characteristics. Our results show that, for each visit, patients with low education get shorter consultations but more medical tests, patients with low income get less of both, and patients with low education/income get less services in monetary terms. We also find that, during a year, patients with low education/income visit the GP more often and receive more services in monetary terms. Thus, GPs treat patients differently according to their socio‐economic status, but we find no support for a social gradient.

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confidence: 58%

Section: Institutional Backgroundmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Socio‐economic status and physicians' treatment decisions

et al. 2017

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“…To our knowledge, the only other previous study using a general indicator was a cross-sectional study using individual-level data on men aged ≥ 67 years from Norway in 2004/5, which found very little evidence of socioeconomic differences in waiting time after adjusting for all primary and secondary diagnoses, severity and hospital supply. 167 By contrast, previous disease-specific studies have generally found pro-rich inequality in waiting time for publicly funded inpatient hospital treatment in a range of high-income countries with universal health systems. 168,169 Previous disease-specific studies have also found a trend of reducing socioeconomic inequality in the English NHS during the 2000s, for a handful of common non-emergency hospital procedures such as hip replacement, knee replacement cataract, heart bypass and coronary angioplasty.…”

Section: Waiting Timementioning

confidence: 89%

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

Cookson

Asaria

Ali

et al. 2016

Health Serv Deliv Res

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Background: Inequalities in health-care access and outcomes raise concerns about quality of care and justice, and the NHS has a statutory duty to consider reducing them. Objectives: The objectives were to (1) develop indicators of socioeconomic inequality in health-care access and outcomes at different stages of the patient pathway; (2) develop methods for monitoring local NHS equity performance in tackling socioeconomic health-care inequalities; (3) track the evolution of socioeconomic health-care inequalities in the 2000s; and (4) develop ‘equity dashboards’ for communicating equity findings to decision-makers in a clear and concise format. Design: Longitudinal whole-population study at the small-area level. Setting: England from 2001/2 to 2011/12. Participants: A total of 32,482 small-area neighbourhoods (lower-layer super output areas) of approximately 1500 people. Main outcome measures: Slope index of inequality gaps between the most and least deprived neighbourhoods in England, adjusted for need or risk, for (1) patients per family doctor, (2) primary care quality, (3) inpatient hospital waiting time, (4) emergency hospitalisation for chronic ambulatory care-sensitive conditions, (5) repeat emergency hospitalisation in the same year, (6) dying in hospital, (7) mortality amenable to health care and (8) overall mortality. Data sources: Practice-level workforce data from the general practice census (indicator 1), practice-level Quality and Outcomes Framework data (indicator 2), inpatient hospital data from Hospital Episode Statistics (indicators 3–6) and mortality data from the Office for National Statistics (indicators 6–8). Results: Between 2004/5 and 2011/12, more deprived neighbourhoods gained larger absolute improvements on all indicators except waiting time, repeat hospitalisation and dying in hospital. In 2011/12, there was little measurable inequality in primary care supply and quality, but inequality was associated with 171,119 preventable hospitalisations and 41,123 deaths amenable to health care. In 2011/12, > 20% of Clinical Commissioning Groups performed statistically significantly better or worse than the England equity benchmark. Limitations: General practitioner supply is a limited measure of primary care access, need in deprived neighbourhoods may be underestimated because of a lack of data on multimorbidity, and the quality and outcomes indicators capture only one aspect of primary care quality. Health-care outcomes are adjusted for age and sex but not for other risk factors that contribute to unequal health-care outcomes and may be outside the control of the NHS, so they overestimate the extent of inequality for which the NHS can reasonably be held responsible. Conclusions: NHS actions can have a measurable impact on socioeconomic inequality in both health-care access and outcomes. Reducing inequality in health-care outcomes is more challenging than reducing inequality of access to health care. Local health-care equity monitoring against a national benchmark can be performed using any admini...

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“…Several recent studies examine the relationship between waiting times and socioeconomic status (Carlsen and Kaarbøe, 2012;Kaarbøe and Carlsen, 2014;Johar et al, 2013;Siciliani and Verzulli, 2009). All of these studies find higher income and education to be associated with lower waiting times for public health services.…”

Section: Detecting Discrimination In Health Carementioning

confidence: 97%