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Equitable choices for Health

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Equitable choices for Health

  1. 1. Equitable choices for Health Jessica Allen Institute for Public Policy Research www.ippr.org
  2. 2. Key messages• Choice could increase inequities if it is not geared towards disadvantaged• Equitable, progressive vision of choice could reduce inequities and achieve wider benefits• White Paper makes progress, but more needs to be done
  3. 3. One of Main Drivers of Health Service Reform• Choice – reduce waiting lists• Choice – drive up quality• Choice – inform engage and hand power to groups, communities and individuals.
  4. 4. • Think of the responsible parent, the informed patient, the active citizen and the dedicated teacher, nurse or local public servant who - with an extension of choice and voice, individual and collective - are taking control and driving change forward.Gordon Brown Feb 27 06
  5. 5. Inequalities in Health• Very varied life expectancy, years spent in good health• Depend partly on access to health services – inequities in health care.
  6. 6. Healthcare inequities• Equity founding principle of NHS but…• Health care inequity within the NHS• Social classes IV and V had 10% fewer preventive consultations than social classes I and II• Hip replacements were 20% lower among lower SEGs despite roughly 30% higher need• Intervention rates of CABG or angiography following heart attack were 30% lower in lowest SEG than the highest.
  7. 7. ‘People in poorer families and some minority ethnic groups get less satisfactory treatment. ‘Well-informed, middle class people are often better at getting what they need. ‘Every health authority should be under a statutory duty to reduce inequities in health care provision.’
  8. 8. Unequal access in primary care
  9. 9. Causes of inequity: supply• Under-doctored areas• Distance, registration• Relative quality• Professional beliefs and attitudes• One-size-fits-all
  10. 10. Unequal quality• Time with GP• Satisfaction and benefit per consultation• Treatment and referral rates
  11. 11. Causes of inequity: demand• Unequal resourcesTransport, work and personal commitments• Unequal ‘Choosability’Capabilities, beliefs, knowledgeInverse information lawParticipation in decision-making
  12. 12. Equity and choosability• Patients currently inequitably involved in decisions• Pilots show equitable choosing is possible in acute sector• …but limited applicability to wider health and care choices…• …and lessons not being rolled out
  13. 13. Choice and Equity in White PaperSupply Quantity: – Under-doctored areas – Resource shift to primary care and prevention Quality – Commissioning and regulation
  14. 14. Choice and equity in White PaperDemand:Work and personal commitmentsTransport to primary care‘Choosability’ Health beliefs, capabilities, knowledge? Professional beliefs and attitudes?
  15. 15. Equity and choosabilityAccessInformationSupport and advocacyProfessional attitudes
  16. 16. Theory of Choice• Choice as citizen empowerment• Choice as consumerism• Choice as market• Choice as co-production
  17. 17. Key messages• Choice could increase inequities if it is not geared towards disadvantaged• Equitable, progressive vision of choice could reduce inequities and achieve wider benefits• White Paper makes progress, but more needs to be done

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