Healthy, wealthy and more healthcare too

Better-off patients get more from the NHS than the poor, says a report that shatters any popular notion of an equitable health service.

Downing Street policy adviser Professor Julian Le Grand and Department of Health strategy adviser Anna Dixon concluded there was ‘strong evidence’ that lower socio-economic groups use health services less in relation to need than richer patients.

They said the challenge for government is to draw up policies that address the barriers to treatment faced by poorer groups.

‘Affluent achievers’ were 40 per cent more likely to get a heart bypass than the ‘have-nots’, despite their lower mortality from heart disease. Poorer people were also 20 per cent less likely to get hip replacements despite roughly 30 per cent higher need.

The poor tended to go to the GP later or not at all, to go to emergency departments instead of GPs and to use prevention services less than the better off.

They had lower rates of referral and intervention relative to need and irregular attendance at chronic disease management clinics. Middle class patients got more out of the health service because they were more articulate, confident and persistent, said the paper.

The report claimed that ‘preliminary analysis’ of data from the London Choice pilot – where patients are offered the choice to go to another hospital for quicker treatment – suggests no relationship between the PCT deprivation index and the take-up of choice. It argued that this suggested the poor were as interested in the opportunities offered by increased choice as the more affluent.

Professor Le Grand, who has acted as an adviser to the World Bank, told healthmatters: ‘My own view is that a large part of the problem arises because the poor are not very well equipped to manipulate the system.’