Easy access to quality medical care is considered a benchmark standard of a first world nation, distinguishing it from developing countries.
In such healthcare systems, high-quality treatment is fundamental, alongside equity, patient-centredness and transparency. The UK’s National Health Service (NHS) is a successful model that other nations look to for inspiration. Free at the point of contact and available to all, the NHS is a shining example of what healthcare should be, underpinned by a basic principle: wealth should not influence health.
But how do we ensure that the offer of free, high-quality healthcare translates into real access for everyone? According to our research even in cases where medical care is available at no cost, not everyone ends up choosing the best healthcare provider available to them. We found that a key driver of the disparities in healthcare are disparities in information.
A health access gap
It won’t come as a surprise to some to hear of inequalities in medical care – even in free healthcare systems. It’s a pervasive issue that countless countries are battling. According to the Financial Times, in February this year the UK government announced it would be offering cash incentives to dental practices to incentivise taking on new patients, as it was revealed that more than 80% of practices were not accepting new patients over the age of 18. Meanwhile, in Canada, a report published in 2023 surveying people between 2019-21 revealed that 12% of people aged 12 and older, excluding those in Quebec, did not have access to a regular healthcare.
Evidently, this healthcare access gap extends beyond emergency treatment at a hospital. The access/quality gap often manifests when prospective patients look for care from local doctors, or ‘general practitioners’ (GPs). A worrying trend in the case of the NHS in England is that those from more deprived areas often sign up to receive care from lower rated GPs – risking receiving a lower quality of care. Despite the absence of cost, those in poorer communities are choosing to register with lower rated GPs. Why do low-income patients tend to go to lower quality healthcare providers?
Our study, “Information and Disparities in Health Care Quality: Evidence from Gp Choice in England”, sought to answer that question.
Inequalities in information
Traditionally, policymakers have focused on logistical barriers to access to quality care (geographical proximity, transportation challenges etc.), overlooking the role that inequalities in information play in this gap. We discovered that information is a key driver behind the gap in access to quality healthcare.
We studied the percentage of patients in each English neighbourhood who opted to register with one of the top-rated practices within a 3km radius of where they lived and discovered that residents in high-income communities consistently chose the best GPs, while the choices of those in low-income neighbourhoods seemed almost random.
Our analysis revealed that high-income patients chose better GPs, at least in part, thanks to access to more precise information. These individuals were better equipped to research the quality of GP’s surgeries in their local area and were more likely to get recommendations from their networks, which often include healthcare practitioners.
Patients with lower-incomes meanwhile, were more likely to depend on information provided by sources such as the NHS.
The NHS website provides information to help patients choose a GP practice, hospital, dentist, or other healthcare provider, receiving over one billion visits per year. Between 2007 and 2019, the NHS’ GP practice rating system – NHS Choices – alongside displaying patient reviews, also included a star rating (a summary indicating the average of previous reviews, much like the one used on websites like Amazon or TripAdvisor). However, these star ratings were removed in 2020, making this crucial information more difficult to access.
Our research shows that, when this information became less visible, it hindered patients’ ability to choose the best GP available to them. We found this only had a small impact on people living in more affluent areas. However, the effect was felt more profoundly by people living in poorer areas for whom the NHS website was a key source of information. When the summary star rating system disappeared from the website, individuals from poorer neighbourhoods began choosing their GPs almost at random.
Disparities in access to information around the quality of healthcare providers are easy to overlook on the basis that they are seemingly intangible – it’s a hard thing to put a number to. To boost clarity, our research sought to do exactly that and, by doing so we found that inequality in access to information accounted for 24% of the link between income and GP quality, significantly amplifying disparities in healthcare access.
How can policymakers remedy the information gap? As a starting point, restoring crucial information provided by the NHS’ website is an important first step. We need to collect information about GP quality, and then make it widely and easily available. Via NHS Choices and its star ratings system, the NHS had done just that, so the decision of policymakers to remove that information is concerning. Reinstating such a system would enhance the ability of all patients to make better decisions for themselves.
Free healthcare is founded upon the principles of accessibility, equity and quality for all. As it stands, the NHS is not living up to those principles.
This article was authored by Dr Andre Veiga, Assistant Professor of Economics at Imperial College Business School.
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