Identifying individual patients' socio-economic position : a basis for vertical equity approaches in primary health care

Higginson, Martin Richard (2010). Identifying individual patients' socio-economic position : a basis for vertical equity approaches in primary health care. PhD thesis The Open University.

DOI: https://doi.org/10.21954/ou.ro.0000d630

Abstract

This thesis develops an original approach to identify the socio economic position of individual patients at GP practices.

In diverse and densely populated inner city areas, there is reason to expect that an individually based measure of socio-economic position of individuals may be a useful tool to support effective use of resources in primary case. An innovative method of classifying individual patients' socio-economic positions when registering at a GP practice was developed for this purpose. It is argued that this method could be used as a basis for a vertical equity approach to healthcare.

Logistic regression techniques and measures of sensitivity and specificity are used in an original method designed to identify patients to two socioeconomic benchmarks. Criteria are provided for a framework in which decisions can be made to target patients.

The thesis adopts a critical perspective on current thinking around equity in healthcare. Interviews establish that NHS professionals agree that a vertical equity approach would be an effective means to address health inequities. However, they also see significant barriers to adoption of such an approach.

A complex and sophisticated set of issues emerge from qualitative comments from patients concerning this research method. The comments demonstrate a deep engagement with the NHS. They include views on the determinants of health and the way in which healthcare is organised that relate directly to equity in healthcare.

The findings are contextualised in the light of recent government policy proposals and challenge the direction of that policy as being ineffective in addressing health inequities. They also highlight possible future tensions between NHS professionals and patients.