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How a universal health system reduces inequalities: lessons from England

Miqdad, A., Shehzad, A., Doran, T. , Ferguson, B., Fleetcroft, R., Goddard, M., Goldblatt, P., Laudicella, M., Raine, R. & Cookson, R. (2016). How a universal health system reduces inequalities: lessons from England. Journal of Epidemiology & Community Health, 70, pp. 637-643. doi: 10.1136/jech-2015-206742


Background: Provision of universal coverage is essential for achieving equity in healthcare, but inequalities still exist in universal healthcare systems. Between 2004/5 and 2011/12 the English NHS, 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.

Methods: Whole-population small area longitudinal study, based on 32,482 neighbourhoods of approximately 1,500 people in England from 2004/5 to 2011/12. We measured slope indices of inequality in four indicators: (i) patients per family doctor (ii) primary care quality (iii) preventable emergency hospital admissions and (iv) mortality from conditions considered amenable to healthcare.

Results: Between 2004/5 and 2011/12 there were larger absolute improvements on all indicators in more deprived neighbourhoods. The modelled gap between the most and least deprived neighbourhoods in England decreased by: 193 patients per family doctor (95% confidence interval 173 to 213), 3.29 percentage points of primary care quality (3.13 to 3.45), 0.42 preventable hospitalisations per 1,000 people (0.29 to 0.55) and 0.23 amenable deaths per 1,000 people (0.15 to 0.31). By 2011/12 inequalities in primary care supply and quality were almost eliminated but socio-economic inequality was still associated with 158,396 preventable hospitalisations and 37,983 deaths amenable to healthcare.

Conclusions: Between 2004/5 and 2011/12 the NHS succeeded in substantially reducing socioeconomic inequalities in primary care access and quality but made only modest reductions in healthcare outcome inequalities.

Publication Type: Article
Publisher Keywords: Health Inequalities, Primary Care, Access to Health Care, Quality of Health Care, Health Outcomes
Subjects: R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: School of Health & Psychological Sciences
Text - Accepted Version
Available under License Creative Commons: Attribution International Public License 4.0.

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