Health inequalities in access to keloid scar surgery: An analysis of funding criteria and their impact across England.

Background: Keloid scars, which are significantly more common in ethnic minorities, are challenging to treat in England because of funding policies. Overly restrictive funding criteria can have a disproportionate adverse effect on those most prone to keloid, resulting in health inequality. Methods: This cross-sectional study investigated the regional variations in funding criteria for keloid scar surgery across the 42 integrated care boards (ICBs) of England and, through Freedom of Information requests, the number of corresponding applications and approvals in 2023. Potential associations with the Black, Asian and minority ethnic composition of ICB populations were explored. Results: Funding criteria were highly restrictive across all ICBs. Keloid scar surgery applications were almost universally low, with some ICBs reporting <5 or no applications. Acceptance rates were generally low. There was no significant overall correlation between the ethnic proportion of ICBs' populations and number of applications or approval rates. Conclusions: Our findings confirmed that access to keloid surgery is highly restricted nationwide, a situation that likely disproportionately disadvantages the ethnic minorities. The near total lack of ethnicity data collection by ICBs obstructs the full characterisation of this issue. We propose exempting keloids from funding restrictions or at least revising the criteria to account for their symptomatic and psychosocial impact, to help achieve more equitable healthcare policies.