Cost of health inequality to the NHS in Wales
BackgroundForty years from the seminal work of Welsh GP Julian Tudor Hart on the Inverse Care Law, inequalities in health and healthcare remain deeply embedded in Wales. There is a wider gap (over 17 years) in healthy life expectancy between people living in the most and least deprived neighborhoods...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Public Health |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2022.959283/full |
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| author | Rajendra Kadel James Allen Oliver Darlington Rebecca Masters Brendan Collins Joanna M. Charles Miqdad Asaria Mariana Dyakova Mark Bellis Richard Cookson |
| author_facet | Rajendra Kadel James Allen Oliver Darlington Rebecca Masters Brendan Collins Joanna M. Charles Miqdad Asaria Mariana Dyakova Mark Bellis Richard Cookson |
| author_sort | Rajendra Kadel |
| collection | DOAJ |
| description | BackgroundForty years from the seminal work of Welsh GP Julian Tudor Hart on the Inverse Care Law, inequalities in health and healthcare remain deeply embedded in Wales. There is a wider gap (over 17 years) in healthy life expectancy between people living in the most and least deprived neighborhoods in Wales. This health inequality is reflected in additional healthcare use. In this study we estimate the cost of inequality associated with this additional healthcare use to the publicly funded National Health Service (NHS) in Wales.MethodsWe retrieved administrative data on all NHS inpatient admissions, outpatient and accident and emergency attendances in Wales between April 2018 and March 2019 from Digital Health and Care Wales (DHCW). Hospital service use data were translated to costs using Healthcare Resource Group (HRG) and health service specific unit cost data and linked with area level mid-year population and deprivation indices in order to calculate the healthcare costs associated with socioeconomics deprivation.ResultsInequality in healthcare use between people from more and less deprived neighborhoods was associated with an additional cost of £322 million per year to the NHS in Wales, accounting for 8.7% of total NHS hospital expenditure in the country. Emergency inpatient admissions made up by far the largest component of this additional cost contributing £247.4 million, 77% of the total. There are also substantial costs of inequality for A&E attendances and outpatient visits, though not maternity services. Elective admissions overall have a negative cost of inequality, since among men aged 50–75 and women aged 60–70, elective utilization is actually negatively associated with deprivation.ConclusionThere are wide inequalities in health and healthcare use between people living in more deprived neighborhoods and those living in less deprived neighborhoods in Wales. Tackling health inequality through a combination of health promotion and early intervention policies targeted toward deprived communities could yield substantial improvement in health and wellbeing, as well as savings for the Welsh NHS through reduced use of emergency hospital care. |
| first_indexed | 2024-04-11T20:20:06Z |
| format | Article |
| id | doaj.art-6ae43880ec6a4d86bc9544b081e7adea |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-04-11T20:20:06Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj.art-6ae43880ec6a4d86bc9544b081e7adea2022-12-22T04:04:49ZengFrontiers Media S.A.Frontiers in Public Health2296-25652022-09-011010.3389/fpubh.2022.959283959283Cost of health inequality to the NHS in WalesRajendra Kadel0James Allen1Oliver Darlington2Rebecca Masters3Brendan Collins4Joanna M. Charles5Miqdad Asaria6Mariana Dyakova7Mark Bellis8Richard Cookson9WHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United KingdomWHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United KingdomWHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United KingdomWHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United KingdomHealth and Social Services Group, Finance Directorate, Welsh Government, Cardiff, United KingdomHealth and Social Services Group, Finance Directorate, Welsh Government, Cardiff, United KingdomDepartment of Health Policy, London School of Economics and Political Science, London, United KingdomWHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United KingdomWHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United KingdomCentre for Health Economics, University of York, York, United KingdomBackgroundForty years from the seminal work of Welsh GP Julian Tudor Hart on the Inverse Care Law, inequalities in health and healthcare remain deeply embedded in Wales. There is a wider gap (over 17 years) in healthy life expectancy between people living in the most and least deprived neighborhoods in Wales. This health inequality is reflected in additional healthcare use. In this study we estimate the cost of inequality associated with this additional healthcare use to the publicly funded National Health Service (NHS) in Wales.MethodsWe retrieved administrative data on all NHS inpatient admissions, outpatient and accident and emergency attendances in Wales between April 2018 and March 2019 from Digital Health and Care Wales (DHCW). Hospital service use data were translated to costs using Healthcare Resource Group (HRG) and health service specific unit cost data and linked with area level mid-year population and deprivation indices in order to calculate the healthcare costs associated with socioeconomics deprivation.ResultsInequality in healthcare use between people from more and less deprived neighborhoods was associated with an additional cost of £322 million per year to the NHS in Wales, accounting for 8.7% of total NHS hospital expenditure in the country. Emergency inpatient admissions made up by far the largest component of this additional cost contributing £247.4 million, 77% of the total. There are also substantial costs of inequality for A&E attendances and outpatient visits, though not maternity services. Elective admissions overall have a negative cost of inequality, since among men aged 50–75 and women aged 60–70, elective utilization is actually negatively associated with deprivation.ConclusionThere are wide inequalities in health and healthcare use between people living in more deprived neighborhoods and those living in less deprived neighborhoods in Wales. Tackling health inequality through a combination of health promotion and early intervention policies targeted toward deprived communities could yield substantial improvement in health and wellbeing, as well as savings for the Welsh NHS through reduced use of emergency hospital care.https://www.frontiersin.org/articles/10.3389/fpubh.2022.959283/fullcostinequalityhealth service useNHSWales |
| spellingShingle | Rajendra Kadel James Allen Oliver Darlington Rebecca Masters Brendan Collins Joanna M. Charles Miqdad Asaria Mariana Dyakova Mark Bellis Richard Cookson Cost of health inequality to the NHS in Wales Frontiers in Public Health cost inequality health service use NHS Wales |
| title | Cost of health inequality to the NHS in Wales |
| title_full | Cost of health inequality to the NHS in Wales |
| title_fullStr | Cost of health inequality to the NHS in Wales |
| title_full_unstemmed | Cost of health inequality to the NHS in Wales |
| title_short | Cost of health inequality to the NHS in Wales |
| title_sort | cost of health inequality to the nhs in wales |
| topic | cost inequality health service use NHS Wales |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2022.959283/full |
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