Inequities in healthcare Flashcards
Define inequities in healthcare
Inequities in health care are not the same as inequalities in health
Inequities in health care:
Unfair, unavoidable differences in health or healthcare arising from poor governance, corruption or cultural exclusion
What are health inequalities
Health inequalities:
Uneven distribution of health or healthcare as a result of genetic or other factors or lack of resources.
What is good access in healthcare?
Good access= adequate and appropriate supply of health care so that people who need it can access it
NB not everyone has access to adequate and app. healthcare
What is equal access?
What is equitable access?
- Equal access refers to providing the same level of kind of service to everyone, regardless of need
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Equitable access is providing services according to need
- NHS founded on principle of equity
- globally and locally evidence of inequity in healthcare
What are the two types on inequity in healthcare?
Describe them
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Horizontal inequity:
- When people with the same needs do not have access to the same resources
- Unequal treatment of equals
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Vertical inequity:
- when people with greater needs are not provided with greater resources to meet those needs
What is the inverse care law?
The availability of good medical care tends to vary inversely with the need for it in the population served.
Why address inequities in healthcare?
- Social justice and fairness
- growing evidence base that equitable access to medical and health care can contribute towards reductions in health inequalities
- not addressing inequity in access to health care may widen health inequalities
- duty under Equality Act 2010 : public sector duty
Will tackling inequities in health care have an impact on health inequalities?
- It can have some impact:
- fall in CHD mortality attributable to improved tx uptake across all social groups
- increase in proportion of resources allocated to deprived areas (compared w more affluent areas) associated with reduction in absolute health inequalites from causes amenable to healthcare
- Estimated 15-20% life expectancy gap can be influenced by health care interventions
- vital to QOL for pts
What do we need to consider in addressing health inequities?
- inequities in access to services:
- access to facilities
- access to tx and care
- inequities in utilisation of primary and secondary services
- inequities of responsive services
Are there inequities in the quality and supply of primary care?
- Majority of care in general practice is good or adequate
- reduction in inequity of GP supply (national programme to recruit more GP’s in deprived areas
- But –> GP workforce issues
- fewer GPs in more deprived areas
- Timely access to GP services
What is the pro poor bias?
Pro poor bias –> in general those with the greatest health needs have greatest access to GP care
What evidence of horizontal/ vertical inequity is there in primary care?
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Difficulty accessing primary care for some groups:
- Specific groups e.g. asylum seekers, homeless people, travellers
- waiting times to see GP’s
- Lesbian, gay, bisexual, and transgender people tend to have less satisfaction with GP care
- Evidence of under utilisation of preventative services:
- uptake of colorectal cancer screening --> lower in most social disadvantaged quintile compared to least disadvantaged quintile
- low income households –> less likely to take up immunisations in child health screening
What evidence of inequity in secondary care is there?
- Inequities for some types of hospital care:
- total hip arthroplasty post hip fracture
- limited use of THA among pts from deprived areas
- inapp. high use of THA among affluent pts
- Cancer care and survival:
- Inequalities in provision of tx at weekend
- bowel cancer pts in disadvantaged areas –> more emergency admission
- Lung cancer –> most disadvantaged pts less likely to survive
- breast cancer –> young women (under 70 yrs) more likely to receive constructive surgery than older women
- total hip arthroplasty post hip fracture
What evidence is there of inequity in the access to secondary care?
- End of life care –> pts in disadvantaged areas more likely to die in hospital
- Evidence of inequitable access for older people –> less hip and knee replacement provision for 66-84 yrs than other age groups, regardless of need
- Evidence of ethnic inequities in patterns of inpatient tx –> ethnic inequalities in use relative to need of cardiac care services and secondary care for diabetes
- Evidence of poor access for some disabled people –> pepople w learning disabilites poorer access to some aspects of primary and secondary care, + significant levels of untreated ill health and high no. of avoidable deaths
Tackling inequitable access:
What is good access?
How can we explain inequities in health care?
Inequities in healthcare can be a result of:
- Supply side –> provider barriers, NHS and primary care organisations, individual clinicians, government
- Demand side –> user barriers, patient use of helath services, inability to use services
List some of the barries to equitable access:
1) supply side
2) demand side
- Supply side
- lack of funding
- services at wrong time/ place
- costs attached
- culturally inappropriate
- variable quality
- clinician biases
- Demand side
- health literacy
- geographical or physical barriers
- community and cultural attitudes/ norms
How can we address inequities in health care?
- needs multidisciplinary approach
- needs to be driven by information from health impact assessments
- complex and multifaceted
- needs action as organisational level
How can be address barriers to access to health care?
- reduce physical and geographical barriers
- address attitudinal or knowledge biases of clinicians
- reduce variations in quality of services offered to pts with identical needs:
- between areas/ age groups/ ethnic groups/ disabled/ non disabled
- Reduce costs (financial or other) to individuals
- these may vary between populations or people with identical needs
- take account of affordability and indirect costs
- e.g. taking day off work, childcare, prescription and dental costs
- ensure health service information on the availability and type of service is known with equal clarity
- take account of preferences for services in particular locations/ times, services delivered in particular ways
- take account of community and cultural attitudes and norms –> e.g. some groups of women may prefer female clinicians
