Centre for Health Economics, University of York, United Kingdom.
Centre for Health Economics, University of York, United Kingdom; Department of Economics and Related Studies, University of York, United Kingdom.
J Health Econ. 2018 Jan;57:290-314. doi: 10.1016/j.jhealeco.2017.06.005. Epub 2017 Jun 23.
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.
公平获得医疗保健是公共资助医疗体系的一个关键政策目标。然而，观察到的社会经济地位方面的获得机会不平等可能是由于患者选择的差异造成的。利用英国国家医疗服务体系中关于非紧急冠状动脉血运重建手术的数据，我们发现不同社会经济地位的患者在公立医院的等待时间存在实质性差异：最贫困和最不贫困的五分之一人群群体之间的差异高达 35%，即 43 天。使用带有差异距离的选择模型作为识别变量，我们估计这些等待时间不平等中只有高达 12%可以归因于患者对医院和治疗类型（心脏搭桥手术与支架）的选择。在考虑选择因素后，剩余的不平等在经济上具有重要意义：处于最不贫困五分之一群体的患者受益于较短的等待时间，相关的健康益处每人高达 850 英镑。
