BMA should look at inequalities in the NHS

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7035.913b (Published 06 April 1996) Cite this as: BMJ 1996;312:913
  1. John Yates
  1. Director Inter-Authority Comparisons and Consultancy, Health Services Management Centre, Birmingham B15 2RT

    EDITOR,—The BMA's board of science and education argues that inequalities in the health status of the British people persist and regards this as an indictment on a health care system created to provide equal and free access to health care for all, irrespective of income.1 2 The board suggests that the recent reforms of the NHS, rather than improving the situation, may have been detrimental to the principle of equity. It calls for the government to reduce inequalities by taking action in areas related to income, housing, education, taxation policy, behavioural factors (for example, smoking), psychosocial factors, genetic issues and issues of early life, ethnic minorities, geographical location, leisure activities, and transport. The responsibility for inequity is placed firmly on the government and the patient. Only one sentence in the board's report relates to the process of medical care, acknowledging its importance in reducing variations in morbidity but cautioning readers that it cannot account for the substantial variations in mortality that exist.

    Is it reasonable for the medical profession and others who work in the NHS simply to look elsewhere for the contributory causes of inequality? Should not a concern for inequality start with an examination of how the NHS and its doctors differentiate between rich and poor people? The BMA seems reluctant to discuss the fact that those who pay for health care can expect:

    • speedier access to an outpatient consultation

    • the outpatient consultation to occur in hospitable surroundings, with more time being given to them by the consultant

    • a greater likelihood of surgical intervention (for example, although only 11% of the population is insured, over 30% of hip replacement operations are paid for privately3)

    • a shorter wait before being operated on

    • the operation to be performed by the consultant.

    The BMA has recently expressed concern over the establishment of a private primary health care service, saying, “It would worry us if any private company were to pick off patients on the basis of ability to pay.”4 Is there not some hypocrisy in this attitude when the medical profession remains willing to treat an increasing number of private patients not because of their clinical need but because of their ability to pay?


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