Older people on higher incomes are more likely to access health care services than their less well off counterparts. That is the central conclusion of new research by Sara Allin, the London School of Economics and Political Science (LSE), and colleagues, presented at the British Household Panel Survey 2005 conference at the Institute for Social and Economic Research (ISER) on Friday 1 July.
Using six years of data from the British Household Panel Survey (1997-2002), their study reveals that income matters for over 65s when it comes to access to health care services. Despite being in better health (in terms of number of health problems, self-reported health status, and activity limitations), wealthier older people are significantly more likely to see a doctor, a specialist or a dentist and be admitted to hospital.
One of the goals of the NHS is to ensure that health care services are provided on the basis of need and not ability to pay - otherwise known as equity of access to health care - mainly by providing services free at the point of use. This study shows that among older people living in the UK this principle is being violated.
The most striking violation of the equity principle is in specialist care and dental care - where, once controlled for differences in need, individuals in the richest 20 per cent of the population are 30 per cent more likely to visit a specialist and 60 per cent more likely to visit a dentist than those in the poorest 20 per cent of the population.
The inequities are less significant in GP and hospital care, with individuals in the highest income group 5 per cent and 12 per cent more likely than the lowest to visit a GP and be admitted to hospital, respectively.
It is likely that the significant inequity in dental care is due in large part to the hefty costs - even NHS patients have to pay 80 per cent of the treatment costs, which can be significant, particularly at older ages. Since the majority of older people receive no assistance with these costs - they most surely deter those less financially secure from seeking care.
The reasons behind the sizeable inequity in specialist care are less clear, and are likely to be due to factors related to income such as education, and possibly reflecting their use of the private sector.
This is the first study to investigate fairness in service use specifically among older people and measure the presence and extent of inequity, thus it serves as a useful tool in evaluating the NHS and highlighting weaknesses in the system.
While a recent analysis of equity in service use among the general British population only found significant inequity in dental care and not in other areas of medical care, it appears that income matters more among the older age groups.
Sara Allin comments: 'As the highest consumers of health care, and with potentially more barriers to access, more attention should be paid to patterns of service use among older people and to addressing existing inequities.'
For further information, contact:
During the conference: contact Janice Webb on 07909 514422.
Notes for editors:
Equity and Inequality in Health Care Use Among Older People in the United Kingdom by Sara Allin and colleagues was presented at the British Household Panel Survey 2005 conference at the Institute for Social and Economic Research (ISER), Essex.
Sara Allin is a Research Fellow at the London School of Economics and Political Science (LSE).
4 July 2005