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Researchers say inequality costs the NHS £4.8 billion a year

Posted on 17 May 2016

Socio-economic inequality costs the NHS in England £4.8 billion a year, almost a fifth of the total NHS hospital budget, according to researchers at the University of York.

The research team found that the more deprived the neighbourhood that someone lives in, the sicker they tend to be and the more likely they are to require admission to hospital. This ‘social gradient’ in poor health affects everyone in the country, not just those in the most deprived neighbourhoods, the authors conclude.

People living in the most deprived fifth of neighbourhoods have 72% more emergency hospital admissions and 20% more planned admissions than people living in the most affluent fifth of neighbourhoods, the study reveals.

As a result, average hospital costs for the poorest people are almost 50% higher than those for the richest, and there is an eight year gap in life expectancy for men and a six year gap in women between people living in the most deprived and most affluent neighbourhoods.

Over their lifetimes, men living in the most deprived neighbourhoods cost the NHS 16% more than men living in the most affluent neighbourhoods, despite having shorter life expectancies. Women living in the most deprived neighbourhoods cost 22% more than women living in the most affluent neighbourhoods, the authors conclude.

Miqdad Asaria, from the University of York’s Centre for Health Economics, said: “At a time when the NHS budget is under a great deal of pressure this study shows that socio-economic inequalities in society are exacting a huge bill on the health service.

“In addition to the strong moral case for tackling the unjustifiable differences in health between the rich and the poor there is also a strong financial case for doing so.”

The study, published in the Journal of Epidemiology and Community Health, used official government data on every single hospital admission and death in the country between April 2011 and April 2012.

It shows that reducing the causes of excess illness associated with deprivation will both extend lives and result in significant savings to the NHS.

However, for this to happen policies will need to be put in place to tackle the underlying causes of illness early on in life – these are largely policies outside the scope of the NHS.

The NHS hospital budget makes up a fifth of the total NHS budget of approximately £100 billion. If similar inequalities were to be observed in other parts of the NHS, such as primary and specialist care, the total cost of inequality to the NHS would be almost £20 billion, the report’s authors conclude.

Further information:

  • This study is Independent research funded by Dr Richard Cookson's National Institute for Health Research (NIHR) Senior Research Fellowship (SRF-2013-06-015). The funding body did not play any role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.
  • The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. The NIHR is the research arm of the NHS. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its worldclass infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (

The paper can be found here:

Asaria M, Doran T, Cookson R The costs of inequality: whole-population modelling study of lifetime inpatient hospital costs in the English National Health Service by level of neighbourhood deprivation, JECH 2016, doi:10.1136/jech-2016-207447

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