233904 Tackling the inverse care law in the UK

Monday, November 8, 2010 : 10:50 AM - 11:10 AM

Rosalind Raine, BSc MBBS MSc PhD FFPH , Department of Epidemiology & Public Health, University College London, England, London WC1 6BT, United Kingdom
“The availability of good medical care tends to vary inversely with the need for it” (Inverse Care Law)

Does the availability of health care vary by socioeconomic circumstances in the UK? The National Health Service (NHS) is a tax funded system based upon the premise of universal access to health care, based solely on clinical need. I examine the extent to which this is achieved.

In what circumstances are health care inequalities likely to occur? I present the results of research investigating inequalities in referral from primary to secondary care.

Do they matter? Health care inequalities may not be justifiable in terms of variations in treatment effectiveness. I demonstrate this in a national analysis of secondary drug prevention for stroke patients.

Will policies to improve access to health care reduce health inequalities? I outline our current approach to how resources should be distributed to reduce inequalities.

What are the best ways to tackle the inverse care law? These are debates concerning: the primacy of state intervention versus individual freedom; whether we should address the inequalities gap or the gradient; the benefits of national versus local approaches to reducing health care inequalities; and current UK policy emphasis on behaviour change of the patient versus that of the health care professional. The rationale for and against each of these issues is discussed.

What is the best way forward? I suggest key policy and research requirements for achieving health care equity.

Learning Areas:
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
To demonstrate that health care inequalities occur even in a tax funded universal health care system. To identify circumstances in which health care inequalities occur in such a system. To demonstrate why health care inequalities matter. To analyse the best ways to tackle the inverse care law.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am Professor of Health Care Evaluation at university College London. I lead the largest health care inequalities research group in the uk.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.