Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-23T04:19:31.821Z Has data issue: false hasContentIssue false
  • English
  • Français

Access to health care services – an English policy perspective

Published online by Cambridge University Press:  01 April 2009

MARIA GODDARD
MARIA GODDARD*
Affiliation:
Centre for Health Economics, University of York, York, UK
*
*Correspondence to: Maria Goddard, Professor of Health Economics, Centre for Health Economics, University of York, York, YO10 5DD, UK. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract:

The English government has given a commitment to improving access to health care services for particular groups perceived as being under-served, or served inappropriately, by existing services. In this article four examples of policies aimed at improving access are considered: enhancing the supply of services to under-served areas, changing the organization of services, setting targets to improve access, and empowering people to make choices. Policies aimed at improving access will work only if they address the source of inequities, which means identifying the key barriers to access and these barriers are unlikely to be uniform across sectors, services, and groups of people. Evidence on the success of these four types of intervention in terms of influencing access and equity of access is discussed, borrowing some concepts from the sociological literature that enable us to understand the importance of how barriers to access may arise for different services and different population groups. It is clear that some policies may not work as well as we would hope, or may even exacerbate inequities of access, because they fail to recognize the source of the particular barriers faced by some groups.

Type
Special Section on Access to Health Care
Information
Health Economics, Policy and Law , Volume 4 , Issue 2 , April 2009 , pp. 195 - 208
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aday, L.A. and Andersen, R.M. (1981), ‘Equity of access to medical care: a conceptual and empirical overview’, Medical Care, 19(12 suppl): 4–27.CrossRefGoogle ScholarPubMed
Baker, D. and Hann, M. (2001), ‘General practitioner services in primary care groups in England: is there inequity between service availability and population need?’, Health and Place, 7: 67–74.CrossRefGoogle ScholarPubMed
Belsky, J., Melhuish, E., Barnes, J., Leyland, A.H., Romaniuk, H., and National Evaluation of Sure Start Research Team (2006), ‘Effects of Sure Start local programmes on children and families: early findings from a quasi-experimental cross sectional study’, British Medical Journal, 332(7556): 1476–1480.CrossRefGoogle ScholarPubMed
Benzeval, M. and Judge, K. (1996), ‘Access to health care in England: continuing inequalities in the distribution of GPs’, Journal of Public Health Medicine, 18(1): 33–40.CrossRefGoogle ScholarPubMed
Burt, J., Hooper, R., and Jessopp, L. (2003), ‘The relationship between use of NHS Direct and deprivation in southeast London: an ecological analysis’, Journal of Public Health Medicine, 25(2): 174–176.CrossRefGoogle Scholar
Chapman, J., Zechel, A., Carter, Y.H., and Abbott, S. (2004), ‘Systematic review of recent innovations in service provision to improve access to primary care’, British Journal of General Practice, 54(502): 374–381.Google ScholarPubMed
Cooper, D., Arnold, E., Smith, G., Hollyoak, V., Chinemana, F., Baker, M., and O'Brien, S. (2005), ‘The effect of deprivation, age and sex on NHS Direct call rates’, British Journal of General Practice, 55(513): 287–291.Google ScholarPubMed
Coulter, A., Le Maistre, N., and Henderson, L. (2005), ‘Patients’ Experience of Choosing where to undergo Surgical Treatment: Evaluation of London Patient Choice Scheme, Oxford: Picker Institute Europe, pp. 96.Google Scholar
Culyer, A.J., Doorslaer, E.V., and Wagstaff, A. (1992), ‘Comment: Utilization as a measure of equity by Mooney, Hall, Donaldson and Gerard’, Journal of Health Economics, 11(1): 93–98.CrossRefGoogle Scholar
Dawson, D., Jacobs, R., Martin, S., and Smith, P.C. (2004), ‘Evaluation of the London Patient Choice Project: system wide impacts’, Final Report, CHE, University of York, York.Google Scholar
Department of Health (2003), Building on the Best: Choice, Responsiveness and Equity in the NHS, London: Department of Health, pp. 71.Google Scholar
Department of Health (2004), Choose and Book – Patient's Choice of Hospital and Booked Appointment. Policy Framework for Choice and Booking at the Point of Referral, London: Department of Health, pp. 12.Google Scholar
Department of Health (2006), Our Health, Our Care, Our Say: A New Direction for Community Services, London: Department of Health.Google Scholar
Department of Health and Partnerships for Children, Families and Maternity (2007), Maternity Matters: Choice, Access and Continuity of Care in a Safe Service, London: Partnerships for Children, Families and Maternity, pp. 51, http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073312Google Scholar
Department of Health (2008), Choice at Referral – Guidance Framework for 2008/09 London: Department of Health.Google Scholar
Dixon, A. and Le Grand, J. (2006), ‘Is greater patient choice consistent with equity? The case of the English NHS’, Journal of Health Services Research and Policy, 11(3): 162–166.CrossRefGoogle ScholarPubMed
Dixon, A., Le Grand, J., Henderson, J., Murray, R., and Poteliakhoff, E. (2007), ‘Is the British National Health Service equitable? The evidence on socioeconomic differences in utilization’, Journal of Health Services Research and Policy, 12(2): 104–109.CrossRefGoogle ScholarPubMed
Dixon-Woods, M., Cavers, D., Agarwal, S., Annandale, E., Arthur, A., Harvey, J., Hsu, R., Katbamna, S., Olsen, R., Smith, L.K., Riley, R., and Sutton, A.J. (2006), ‘Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups’, BMC Medical Research Methodology, 6: 35.CrossRefGoogle ScholarPubMed
Dixon-Woods, M., Kirk, D., Agarwal, S., Annandale, E., Arthur, T., and Harvey, J. (2005), ‘Vulnerable groups and access to health care’, Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation (NCCSDO), NCCSDO, London.Google Scholar
Ensor, T. and Cooper, S. (2004), ‘Overcoming barriers to health service access: influencing the demand side’, Health Policy Plan, 19(2): 69–79.CrossRefGoogle ScholarPubMed
Exworthy, M. and Peckham, S. (2006), ‘Access, choice and travel: implications for health policy’, Social Policy and Administration, 40(3): 267–287.CrossRefGoogle Scholar
Fotaki, M., Boyd, A., Smith, L., McDonald, R., Roland, M., Sheaff, R., Edwards, A., and Elwyn, G.(2005), ‘Patient choice and the organisation and delivery of health services: scoping review’, Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO), NCCSDO, London, pp. 173.Google Scholar
George, S. (2002), ‘NHS Direct audited’, British Medical Journal, 324(7337): 558–559.CrossRefGoogle ScholarPubMed
Goddard, M. and Smith, P.C. (2001), ‘Equity of access to health care services: theory and evidence’, Social Science and Medicine, 53(9): 1149–1162.CrossRefGoogle ScholarPubMed
Gravelle, H. and Sutton, M. (2001), ‘Inequality in the geographical distribution of general practitioners in England and Wales 1974–1995’, Journal of Health Services Research and Policy, 6(1): 6–13.CrossRefGoogle ScholarPubMed
Gulliford, M. (2002), ‘Availability of primary care doctors and population health in England: is there an association?’, Journal of Public Health Medicine, 24(4): 252–254.CrossRefGoogle Scholar
Gulliford, M., Figueroa-Munoz, J., Morgan, M., Hughes, D., Gibson, B., Beech, R., andHudson, M. (2002), ‘What does “access to health care” mean?’, Journal of Health Services Research and Policy, 7(3): 186–88.CrossRefGoogle Scholar
Hauck, K. and Street, A. (2007), ‘Do targets matter? A comparison of English and Welsh national health priorities’, Health Economics, 16(3): 275–90.CrossRefGoogle Scholar
Hacker, J. and Stanistreet, D. (2004), ‘Equity in waiting times for two surgical specialties: a case study at a hospital in the North West of England’, Journal of Public Health, 26(1): 56–60.CrossRefGoogle Scholar
Hippisley-Cox, J. and Pringle, M. (2000), ‘Inequalities in access to coronary angiography and re-vascularisation: the association of deprivation and location of primary care services’, British Journal of General Practice, 50(455): 449–454.Google Scholar
Hughes, D. and Griffith, L. (1997), ‘Ruling in and ruling out: two approaches to the Micro-rationing of health care’, Social Science and Medicine, 44(5): 589–599.CrossRefGoogle Scholar
Knowles, E., Munro, J., O'Cathain, A., and Nicholl, J. (2006), ‘Equity of access to health care. Evidence from NHS Direct in the UK’, Journal of Telemedicine and Telecare, 12(5): 262–265.CrossRefGoogle ScholarPubMed
McInerney, J., Chillala, S., Read, C., and Evans, A. (2000), ‘Impact of NHS direct on demand for immediate care: target communities show poor awareness of NHS direct’, British Medical Journal, 321(7268): 1077.CrossRefGoogle ScholarPubMed
Mooney, G. (1983), ‘Equity in health care: confronting the confusion’, Effective Health Care, 1: 179–185.Google ScholarPubMed
Mooney, G., Hall, J., Donaldson, C., and Gerard, K. (1991), ‘Utilisation as a measure of equity: weighing heat?’, Journal of Health Economics, 10(4): 475–480.CrossRefGoogle ScholarPubMed
Mooney, G., Hall, J., Donaldson, C., and Gerard, K. (1992), ‘Reweighing heat: response’, Journal of Health Economics, 11(2):199–205.CrossRefGoogle ScholarPubMed
Morris, S., Sutton, M., and Gravelle, H. (2005), ‘Inequity and inequality in the use of health care in England: an empirical investigation’, Social Science and Medicine, 60: 1251–1266.CrossRefGoogle ScholarPubMed
Munro, J., Nicholl, J., O'Cathain, A., and Knowles, E. (2000), ‘Impact of NHS Direct on demand for immediate care: observational study’, British Medical Journal, 321(7254): 150–153.CrossRefGoogle ScholarPubMed
Oliver, A.J. and Evans, J.G. (2005), ‘The paradox of promoting choice in a collectivist system’, Journal of Medical Ethics, 31(4): 187.CrossRefGoogle Scholar
Oliver, A.J. and Mossialos, E. (2004), ‘Equity of access to health care: outlining the foundations for action’, Journal of Epidemiology and Community Health, 58(8): 655–658.CrossRefGoogle ScholarPubMed
Pell, J.P., Pell, A.C.H., Norrie, J., Ford, I., and Cobbe, S.M. (2000), ‘Effect of socio-economic deprivation on waiting time for cardiac surgery: retrospective cohort study’, British Medical Journal, 320: 15–19.CrossRefGoogle Scholar
Shipman, C., Payne, F., Dale, J., and Jessopp, L. (2001), ‘Patient-perceived benefits of and barriers to using out-of-hours primary care centres’, Family Practice, 18(2): 149–155.CrossRefGoogle ScholarPubMed
Spanswick, M. (2003), ‘Access to health care: vulnerable groups in society’, in Costello, J. and Haggart, M. (eds), Public Health and Society, Basingstoke: Palgrave Macmillan, Chapter 5, pp. 83–99.CrossRefGoogle Scholar
Ullah, W., Theivendra, A., Sood, V., Vasireddy, A., and Maryon-Davis, A. (2003), ‘Men and older people are less likely to use NHS Direct’, British Medical Journal, 326(7391): 710.CrossRefGoogle ScholarPubMed
Yong, P.F.K., Milner, P.C., Payne, J.N., Lewis, P.A., and Jennison, C. (2004), ‘Inequalities in access to knee joint replacements for people in need’, Annals of the Rheumatic Diseases, 63(11): 1483–1489.CrossRefGoogle ScholarPubMed