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Equity in access to health care

The election of the Labour government last year shifted the issue of inequality in health to the top of the policy agenda. In its White Paper on the “New NHS”, promises were made about reducing unacceptable variations in services and ensuring fair access. Publication of the Green Paper “Our Healthier Nation” also reinforced the government’s aim of narrowing the health gap. Several national initiatives also have this aim, including the £30 million investment in Health Action Zones which are to target health inequalities and the establishment of a public enquiry into health inequalities, chaired by Sir Donald Acheson. However, much of the action required to tackle inequality will have to be undertaken at a local level. Indeed, the White Paper gave Health Authorities, in conjunction with other organisations inside and outside the NHS, the key task of improving health and reducing inequalities through their Health Improvement Programmes. If this task is to me manageable, those in the NHS will need to disentangle the many and complex stands involved in understanding the issue of inequality in health. This report attempts to clarify what is known in relationship to one of those issues – equity of access to health care services – and to draw out the policy implications of the research on this topic. Following an overview of methodological issues, research evidence on the extent and cause of inequities of access to services in the following five areas is summarised and analysed: GP consultations, acute care, mental illness, prevention and health promotion and long-term care. The policy and research implications are drawn out and some suggestions for future directions are made. The report is aimed at both policy makers and academics interested in the state of existing research and in designing and implementing their own studies into equity of access.