Socioeconomic inequality in access to and quality of emergency care

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.

Co-authors. Ruth Watkinson, Stephanie Gillibrand, Matt Sutton