Equity of access to health care : case studies in primary care and coronary artery surgery
Equity of access to health care was the founding aim of the NHS and
a recent White Paper on NHS reforms re-emphasised its importance.
This thesis consists of two contrasting studies on equity of access
using individual patients as units of analysis. The main objective of
the first study was to examine the equity of access to primary care
services including GP consultation, out-of-hour services and referral
to specialist services. The study involved secondary analysis of
patient questionnaire data from a national survey. The objectives of
the second study were to examine the equity of access to coronary
artery surgery in one health district among those who underwent
coronary angiography, and to examine whether the waiting time for
coronary artery surgery was correlated with clinical need. It involved
retrospective collection of data from medical records using the New
Zealand Priority scores as an indicator of need.
The first study showed that the following patient groups subjectively
experienced disadvantages in several aspects of primary care
services:- younger people, those with poor subjective physical and
mental health, females, non-whites, residents in Inner London and
those in paid work or full-time education. The possible reasons for
these findings were discussed. It was recommended that the delivery
of primary care services should take into account these results and
that further research should be conducted into the extent and nature
of differential patient expectation amongst different patient groups.
The second study did not show any significant inequity of access to
coronary artery surgery according to sex, age, smoking status and
socio-economic status. However, there was little correlation between
clinical need and waiting time for coronary artery surgery. These
results informed subsequent development of cardiology and cardiac
surgery services in the health district. The methodologies used in
these two studies were compared and contrasted.