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Socioeconomic inequality of access to healthcare: Does choice explain the gradient?

Moscelli, Giuseppe, Siciliani, L, Gutacker, N and Cookson, R (2017) Socioeconomic inequality of access to healthcare: Does choice explain the gradient? Journal of Health Economics, 57. pp. 290-314.

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Equity of access is a key policy objective in publicly-funded healthcare systems. However, observed inequalities of access by socioeconomic status may result from differences in patients’ choices. Using data on non-emergency coronary revascularisation procedures in the English National Health Service, we found substantive differences in waiting times within public hospitals between patients with different socioeconomic status: up to 35% difference, or 43 days, between the most and least deprived population quintile groups. Using selection models with differential distances as identification variables, we estimated that only up to 12% of these waiting time inequalities can be attributed to patients’ choices of hospital and type of treatment (heart bypass versus stent). Residual inequality, after allowing for choice,was economically significant: patients in the least deprived quintile group benefited from shorter waiting times and the associated health benefits were worth up to £850 per person.

Item Type: Article
Divisions : Faculty of Arts and Social Sciences > School of Economics
Authors :
Siciliani, L
Gutacker, N
Cookson, R
Date : 23 June 2017
DOI : 10.1016/j.jhealeco.2017.06.005
Copyright Disclaimer : © 2017 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (
Uncontrolled Keywords : Waiting times; Inequalities; Socioeconomic status; Selection bias; Choice
Depositing User : Melanie Hughes
Date Deposited : 13 Mar 2018 09:48
Last Modified : 16 Jan 2019 19:08

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