How a universal health system reduces inequalities: lessons from England

Journal of Epidemiology and Community Health
Miqdad AsariaRichard Cookson

Abstract

Provision of universal coverage is essential for achieving equity in healthcare, but inequalities still exist in universal healthcare systems. Between 2004/2005 and 2011/2012, the National Health Service (NHS) in England, which has provided universal coverage since 1948, made sustained efforts to reduce health inequalities by strengthening primary care. We provide the first comprehensive assessment of trends in socioeconomic inequalities of primary care access, quality and outcomes during this period. Whole-population small area longitudinal study based on 32 482 neighbourhoods of approximately 1500 people in England from 2004/2005 to 2011/2012. We measured slope indices of inequality in four indicators: (1) patients per family doctor, (2) primary care quality, (3) preventable emergency hospital admissions and (4) mortality from conditions considered amenable to healthcare. Between 2004/2005 and 2011/2012, there were larger absolute improvements on all indicators in more-deprived neighbourhoods. The modelled gap between the most-deprived and least-deprived neighbourhoods in England decreased by: 193 patients per family doctor (95% CI 173 to 213), 3.29 percentage points of primary care quality (3.13 to 3.45), 0.42 preventable ho...Continue Reading

References

Jan 1, 1990·Social Science & Medicine·R G Evans, G L Stoddart
May 18, 2000·JAMA : the Journal of the American Medical Association·K FiscellaC M Clancy
Aug 5, 2000·BMJ : British Medical Journal·J Dixon, S Dewar
Sep 15, 2001·Social Science & Medicine·M Goddard, P Smith
Aug 3, 2002·Journal of the National Medical Association·Alan Nelson
Oct 2, 2004·The New England Journal of Medicine·Martin Roland
Sep 7, 2006·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·Soeren MattkeSheila Leatherman
Apr 5, 2007·Journal of Health Services Research & Policy·Anna DixonEmmi Poteliakhoff
Nov 19, 2010·Implementation Science : IS·Joshua R VestKevin M Slawson
Dec 21, 2010·The Milbank Quarterly·Yukiko Asada
Apr 5, 2011·Journal of Epidemiology and Community Health·Johan P Mackenbach
Jun 15, 2011·American Journal of Preventive Medicine·Aakanksha H PandeJoshua A Salomon
Aug 11, 2011·JAMA : the Journal of the American Medical Association·Matthew M Davis, Jennifer K Walter
Jan 10, 2012·Annual Review of Public Health·Sara N BleichThomas A LaVeist
Feb 15, 2012·Journal of Health Services Research & Policy·Nicholas Mays, Stefanie Tan
Apr 2, 2013·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Mark AshworthRobert Fleetcroft
Dec 19, 2013·The Journal of the Royal College of Physicians of Edinburgh·S Purdey, A Huntley
May 7, 2014·Annals of Internal Medicine·Benjamin D SommersKatherine Baicker
May 16, 2014·The New England Journal of Medicine·Martin Roland, Stephen Campbell
Jul 2, 2014·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Gary McLeanStewart W Mercer
Jul 25, 2014·BMJ : British Medical Journal·Matthew Limb
Aug 1, 2015·British Medical Bulletin·Martin WenzlElias Mossialos
Aug 1, 2015·Social Science & Medicine·John FrankAndrew Williams

❮ Previous
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Citations

Dec 7, 2017·Health Economics·Kurt R BrekkeOdd Rune Straume
Apr 17, 2018·The British Journal of Surgery·T E PoultonS R Moonesinghe
Feb 7, 2017·British Journal of Hospital Medicine·Richard Cookson, Andrew Walden
Nov 3, 2016·Circulation. Cardiovascular Quality and Outcomes·Eugene C DePasquale, Jon A Kobashigawa
Nov 3, 2016·Circulation. Cardiovascular Quality and Outcomes·Jonathan D W EvansStephen J Pettit
Apr 19, 2019·American Journal of Public Health·Willem I J de BoerJochen O Mierau
Dec 25, 2019·Journal of Primary Care & Community Health·Mary M FordLouise Cohen
Aug 25, 2018·Neurology. Clinical Practice·Cody L Nathan, Camilo Gutierrez
Dec 7, 2016·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Robert FleetcroftRichard Cookson
Jul 25, 2019·Ciência & saúde coletiva·Luciane Maria Pilotto, Roger Keller Celeste
May 6, 2019·European Journal of Public Health·Myriam Soto-GordoaJavier Mar
Dec 19, 2019·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Pooja SainiMark Gabbay
Jun 28, 2020·Journal of Clinical Psychology in Medical Settings·Sean CowlishawDavid Kessler
Sep 3, 2020·International Journal for Equity in Health·Colin SumpterClaire Mackintosh
Feb 18, 2020·Medical Decision Making : an International Journal of the Society for Medical Decision Making·James Love-KohSusan Griffin
Feb 8, 2020·European Journal of Public Health·Helene Sofie EriksenKjell Haug
Sep 12, 2020·International Journal of Environmental Research and Public Health·Hsin-I ShihChia-Ming Chang
Jan 15, 2021·Journal of Medical Ethics·Cristina Roadevin, Harry Hill
Dec 21, 2019·British Journal of Anaesthesia·Thomas E PoultonUNKNOWN National Emergency Laparotomy Audit project team
Feb 12, 2020·The Journal of Surgical Research·Linda M PakChandrajit P Raut
Mar 18, 2021·Ciência & saúde coletiva·Maria do Carmo LealAntônio Augusto Moura da Silva
May 3, 2021·Multiple Sclerosis and Related Disorders·Enrique Gómez-FigueroaJosé Flores-Rivera
Jul 22, 2021·BMJ : British Medical Journal·Lisa R HirschhornAbiyou Kiflie
Jul 25, 2021·International Journal of Environmental Research and Public Health·Chia-Ming ChangHsin-I Shih
Jul 11, 2021·European Journal of Preventive Cardiology·María Grau
Jul 24, 2021·BMC Health Services Research·Naser DerakhshaniSaber Azami-Aghdash

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