Improving choice for patients from disadvantaged groups should reduce
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《英国医生杂志》
Reforming the NHS to take more account of the needs of patients in disadvantaged groups could help to reduce health inequalities, says a report published this week. It says that current measures to increase patients?choice favour "the healthy, wealthy, and demanding."
The report, from the Institute for Public Policy Research, a left-leaning think tank, argues that although "choice" is at the heart of the government抯 agenda, current policies favour middle class patients who have access to information and transport. It warns that this could lead to "a two-tier health service, where left-behind patients receive poorer quality of care."
The report抯 authors found a wide range of examples of ongoing inequality in access and use of health care in the United Kingdom. They noted that people from lower socioeconomic groups had 20% fewer hip replacements than people from other groups, despite an estimated 30% higher need. Research reviewed in the report showed that a reduction in one point down a seven point deprivation scale equated to GPs spending 3.4% less time with the individual concerned. People from social classes IV and V had 10% fewer consultations about preventive health care than social classes I and II. Also, 1.4 million people miss, turn down, or fail to seek healthcare each year because of problems with transport.
The report recommends a raft of measures to make healthcare choices more effective for the worst-off social groups. These measures are designed to overcome the barriers that prevent people exercising full choices, including lack of information and knowledge, language problems, inadequate transport and information technology, and disability.
Among the recommendations is the introduction of "support prescriptions" that would provide advice or advocacy to patients who are least able to negotiate their way around the NHS. The report suggests larger practice boundaries as a way to encourage GPs to specialise, for example in diabetes or in the health of elderly people, and to widen options for treatment outside hospitals. More funding for patients?groups and community and voluntary organisations could lead to better advice and support and more help with transport for people with mobility problems.
Joe Farrington Douglas, a research fellow at the institute and an author of the report, said: "Giving people more choice is at the heart of the government抯 health reform agenda. But it should be about more than creating a market. Choice can reduce health inequalities but only if new services are provided and people get more help with advice, advocacy, and transport. To ensure that choice works for disadvantaged groups and not just the healthier, the wealthier, and the more demanding, the government needs to commit the necessary resources in information and support and increase real choice outside hospitals."
The report was developed by the institute, a progressive research institute that aims to provide innovative policy solutions. It was based on research carried out through literature reviews, policy analysis, a series of seminars, and meetings with experts and stakeholders, including patients?groups, professionals, academic experts, and policy makers. The institute also worked with Health Link—an organisation concerned with patients?involvement—to consult voluntary and community organisations working with disadvantaged groups. The report was funded by Pfizer.(London Susan Mayor)
The report, from the Institute for Public Policy Research, a left-leaning think tank, argues that although "choice" is at the heart of the government抯 agenda, current policies favour middle class patients who have access to information and transport. It warns that this could lead to "a two-tier health service, where left-behind patients receive poorer quality of care."
The report抯 authors found a wide range of examples of ongoing inequality in access and use of health care in the United Kingdom. They noted that people from lower socioeconomic groups had 20% fewer hip replacements than people from other groups, despite an estimated 30% higher need. Research reviewed in the report showed that a reduction in one point down a seven point deprivation scale equated to GPs spending 3.4% less time with the individual concerned. People from social classes IV and V had 10% fewer consultations about preventive health care than social classes I and II. Also, 1.4 million people miss, turn down, or fail to seek healthcare each year because of problems with transport.
The report recommends a raft of measures to make healthcare choices more effective for the worst-off social groups. These measures are designed to overcome the barriers that prevent people exercising full choices, including lack of information and knowledge, language problems, inadequate transport and information technology, and disability.
Among the recommendations is the introduction of "support prescriptions" that would provide advice or advocacy to patients who are least able to negotiate their way around the NHS. The report suggests larger practice boundaries as a way to encourage GPs to specialise, for example in diabetes or in the health of elderly people, and to widen options for treatment outside hospitals. More funding for patients?groups and community and voluntary organisations could lead to better advice and support and more help with transport for people with mobility problems.
Joe Farrington Douglas, a research fellow at the institute and an author of the report, said: "Giving people more choice is at the heart of the government抯 health reform agenda. But it should be about more than creating a market. Choice can reduce health inequalities but only if new services are provided and people get more help with advice, advocacy, and transport. To ensure that choice works for disadvantaged groups and not just the healthier, the wealthier, and the more demanding, the government needs to commit the necessary resources in information and support and increase real choice outside hospitals."
The report was developed by the institute, a progressive research institute that aims to provide innovative policy solutions. It was based on research carried out through literature reviews, policy analysis, a series of seminars, and meetings with experts and stakeholders, including patients?groups, professionals, academic experts, and policy makers. The institute also worked with Health Link—an organisation concerned with patients?involvement—to consult voluntary and community organisations working with disadvantaged groups. The report was funded by Pfizer.(London Susan Mayor)