ArticleJournal of epidemiology and community health2016
How a universal health system reduces inequalities: lessons from England.
Article in Journal of epidemiology and community health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 2 of them syntheses that pooled it.
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Who cites it
61 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Interventions to improve access to cancer care in underserved populations in high income countries: a systematic review.Oncology reviews · 2024Pooled it
- Socioeconomic inequalities in hospitalizations for chronic ambulatory care sensitive conditions: a systematic review of peer-reviewed literature, 1990-2018.International journal for equity in health · 2020Pooled it
- Trial
- How equity in cancer services has been defined and measured, and why it matters: a scoping review of Universal Health Coverage systems.Global health action · 2026Article
- Article
- Inequities in Waiting Times for Major Elective Surgery Before and After the COVID-19 Pandemic: Socioeconomic and Sex Differences in the Southern Barcelona Metropolitan Area.Healthcare (Basel, Switzerland) · 2026Article
- Does lifestyle explain the relationship between socioeconomic position and multimorbidity of cancer and cardiometabolic diseases? A mediation analysis applied to the European Prospective Investigation into Cancer and Nutrition.Journal of epidemiology and community health · 2025Article
- Modeling COVID-19 response in Cuba: a hybrid approach combining agent-based modeling and time series analysis.Population health metrics · 2025Article
- Quality and outcomes framework achievement and unplanned admissions for cardiovascular disease.BMC health services research · 2025Article
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- Emergency Healthcare Utilization and Unmet Care Needs in Chemsex Users: A Cross-Sectional Survey among Sexual Minority Men.Journal of community health · 2025Article
- The Health of Those Who Feed Us: An Assessment of Health Inequities Along the United States Food Chain.International journal of social determinants of health and health services · 2025Article
- Adjusting primary-care funding by deprivation: a cross-sectional study of Lower layer Super Output Areas in England.BJGP open · 2025Article
- The association between confidence in health system and self-rated health: from the perspective of regional comparison.Frontiers in public health · 2025Article
- Article
- Cohort trends in intrinsic capacity in England and China.Nature aging · 2025Article
- All-cancer incidence and mortality in Pakistanis, Bangladeshis, and their descendants in England and Wales.BMC public health · 2024Article
- The reliability and validity of a novel clinical tool for distributing rehabilitation patients: a multicenter cross-sectional study in China.Scientific reports · 2024Article
- Are private hospital emergency departments in Australia distributed to serve the wealthy community?Health care science · 2024Article
- GP working time and supply, and patient demand in England in 2015-2022: a retrospective study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024Observational
1 more citing papers are in PubMed but not listed here.
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10 authors.
Funding
Abstract
backgroundProvision of universal coverage is essential for achieving equity in healthcare, but inequalities still exist in universal healthcare systems. Between 2004/2005 and 2011/2012, the National Health Service (NHS) in England, which has provided universal coverage since 1948, made sustained efforts to reduce health inequalities by strengthening primary care. We provide the first comprehensive assessment of trends in socioeconomic inequalities of primary care access, quality and outcomes during this period.
methodsWhole-population small area longitudinal study based on 32 482 neighbourhoods of approximately 1500 people in England from 2004/2005 to 2011/2012. We measured slope indices of inequality in four indicators: (1) patients per family doctor, (2) primary care quality, (3) preventable emergency hospital admissions and (4) mortality from conditions considered amenable to healthcare.
resultsBetween 2004/2005 and 2011/2012, there were larger absolute improvements on all indicators in more-deprived neighbourhoods. The modelled gap between the most-deprived and least-deprived neighbourhoods in England decreased by: 193 patients per family doctor (95% CI 173 to 213), 3.29 percentage points of primary care quality (3.13 to 3.45), 0.42 preventable hospitalisations per 1000 people (0.29 to 0.55) and 0.23 amenable deaths per 1000 people (0.15 to 0.31). By 2011/2012, inequalities in primary care supply and quality were almost eliminated, but socioeconomic inequality was still associated with 158 396 preventable hospitalisations and 37 983 deaths amenable to healthcare.
conclusionsBetween 2004/2005 and 2011/2012, the NHS succeeded in substantially reducing socioeconomic inequalities in primary care access and quality, but made only modest reductions in healthcare outcome inequalities.
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