Kendall, EAD; (2014) An economic analysis of the contribution of health care to health inequality. Doctoral thesis , UCL (University College London).

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Abstract

Reducing socioeconomic-related health inequalities has been a pressing concern for many years, and the focus of much academic research. Until now, however, there have been few e orts to quantify the contribution that health care makes to health inequality. Our contention is that if health care increases health, the distribution of health care a ects health inequality, therefore changes in the distribution of health care can be used to reduced health inequalities. We begin by reviewing the literature on the e ects of health care on health and health inequality. Next, we show how a cross-sectional model of the e ect of health care on health can be used to examine the contribution of health care to health inequality. Through this we nd that for the area-level e ect of spending on mortality in England, cancer spending leads to a signi cant reduction (approximately 50%) in cancer mortality inequalities but Coronary Heart Disease (CHD) spending does not. We move on to consider the limitations of modelling health inequality over time when using area-level data and suggest a methodological innovation, using a country-level analysis to demonstrate its application. Returning to the setting of English cancer and CHD mortality we show that the results of an analogous panel data model support our earlier ndings. Finally, we use individual-level data to examine the e ect that health spending has on health care utilisation, the e ect utilisation has on health, and how these e ects contribute to health inequality. We nd that here is no e ect on health from General Practitioner visits. Inpatient days do increase health and, overall, reduce health inequalities by 40%. These ndings show the inherent di culty of measuring the e ect of health care on health, but do suggest that health care is currently making substantial contributions to the reduction of health inequalities.

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