Socioeconomic inequality in access to and quality of emergency care
Alexander Turner, Presidential Research Fellow, University of Manchester
Department Research Seminars
Wednesday, 20 January 2021, 2pm to 3pm
Hosted by HERC
DATE & TIME: Wednesday, 20th January 2021, 2:00 pm (UK GMT)
TO REGISTER: This is a free event and will be taking place online via Zoom. Please complete this form to register.
Abstract: Across many developed countries there exists evidence of substantial inequalities in health by socioeconomic status.Inequalities in access to timely and appropriate care could be an important determinant of health inequalities.
Evidence from publicly-funded healthcare systems, where waiting time for care should be based on need rather than ability to pay, have found that individuals with lower socioeconomic status face extended waits for elective care, conditional on need.
We add to this literature by examining inequalities in access to care in emergency departments, where waiting times depend on a more complex set of physician decisions, and where consequences of extended waits for patient health may be more severe.
Using data on all attendances at all major emergency departments (EDs) in England during the 2015/16 financial year, we find that after controlling for patient severity, waiting time between arrival at ED and treatment initiation increases linearly with worsening income deprivation. However the relationship between deprivation and time between treatment initiation and ED departure (and therefore total ED waiting time) follows an n-shaped pattern, driven by the most income-deprived individuals receiving less complex treatment and being less likely to be admitted. This translates into worse patient outcomes, with more deprived individuals being more likely to re-attend ED within 7 days and more likely to die within 30 days. We find these inequalities are driven primarily by differential outcomes within EDs, but that between-ED factors exacerbate these inequalities.
Biography: Alex is a Research Fellow in Health Economics. His research primarily focuses on the development and application of econometric techniques to evaluate changes to the organisation and financing of healthcare. This includes large scale evaluations of hospital financial incentive schemes, the devolution of health and social care powers to Greater Manchester (GM Devo), and interventions to improve social and emotional well-being in childhood.
In October 2019, Alex began a 3-year Presidential Fellowship at the University of Manchester titled "Development of specialist skills to evaluate organisational and service delivery interventions". The fellowship will develop and test new econometric techniques for the evaluation reform implemented via staged roll-out, and apply these techniques to examine the effects of a financial incentive scheme targeting reductions in smoking during pregnancy.