Access to care is not equal. An unofficial 2 tier system is worse that an official and regulated one.

Healthcare has never been equal, but from 1948 we really attempted to make it so. Without short waiting times and high standards, and choice, the inequality will rise as more and more choose to pay. An unofficial 2 tier system is worse that an official and regulated one.

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In a letter to the BMJ S Michael Crawford explains: Access to care is not equal (BMJ 2017;358:j3653 )

When more patients than previously are being denied access to care and some of them are consequently initiating exceptional or individual funding requests,12 the question of fairness arises. We already know that access to joint replacements is lower in deprived areas.3 Perhaps patients from the articulate and assertive end of the social spectrum are more likely to ask their GPs to pursue an individual funding request.

Socioeconomic status is known to determine health, but its effect on uptake of healthcare is rarely highlighted. Michael Marmot, in his book The Health Gap, says that survival of poorer patients with cancer after treatment is inferior, but he discounts the possibility that this might be related to access.4 Evidence indicates that residents of poorer neighbourhoods have reduced access, which is exacerbated by distance from services.5 A study, reported in The BMJ as Research News, showed that many patients who present to the emergency department with cancer have not seen a GP, and this was commoner in those from deprived areas.67

Nine further studies appeared in The BMJ in the first six months of 2017, either as research papers or reported as Research News, which looked at patients’ access to services in relation to deprivation.8910111213141516 Other reported studies that used big data mention using deprivation scores to adjust the statistical model in the analysis of their topic of interest, potentially forfeiting important understanding about the effect of socioeconomic status in patients’ access to services.

The assumption that the NHS is equitable must be tested. International comparisons show us to have a small, inexpensive healthcare system. It inevitably functions as a competition between patients. We must measure the different effects of increasing financial pressures on the varying strata of society.

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This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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