Brendan Walsh (
Mauro Laudicella is a senior lecturer at City University of London.
Health Aff (Millwood). 2017 Jul 1;36(7):1218-1226. doi: 10.1377/hlthaff.2017.0167.
In universal health care systems such as the English National Health Service, equality of access is a core principle, and health care is free at the point of delivery. However, even within a universal system, disparities in care and costs exist along a socioeconomic gradient. Little is known about socioeconomic disparities at the end of life and how they affect health care costs. This study examines disparities in end-of-life treatment costs for cancer patients in England. Analyzing data on over 250,000 colorectal, breast, prostate, and lung cancer patients from multiple national databases, we found evidence illustrating that disparities are driven largely by the greater use of emergency inpatient care among patients of lower socioeconomic status. Even within a system with free health care, differences in the use of care create disparities in cancer costs. While further studies of these barriers is required, our research suggests that disparities may be reduced through better management of needs through the use of less expensive and more effective health care settings and treatments.
在全民医疗保健系统中，如英国国民医疗服务体系，平等获得医疗保健是一个核心原则，并且医疗保健在提供时是免费的。然而，即使在全民医疗体系中，沿着社会经济梯度，护理和成本方面仍然存在差异。关于生命末期的社会经济差异以及它们如何影响医疗保健成本，人们知之甚少。本研究考察了英国癌症患者临终治疗费用方面的差异。通过对来自多个国家数据库的超过 250000 名结直肠癌、乳腺癌、前列腺癌和肺癌患者的数据进行分析，我们发现有证据表明，这种差异主要是由于社会经济地位较低的患者更多地使用急诊住院治疗所致。即使在一个医疗保健免费的体系中，护理使用方面的差异也会导致癌症成本方面的差异。虽然需要进一步研究这些障碍，但我们的研究表明，通过在成本效益更高的医疗环境和治疗方法中更好地管理需求，可以减少差异。
