Hospital admissions for severe mental illness in England: changes in equity of utilisation at the small area level between 2006 and 2010.
Bottom Line: Our results suggest that one additional percentage point of area income deprivation is associated with a 1.5% (p<0.001) increase in admissions for SMI after controlling for population size, age, sex, prevalence of SMI in the local population, as well as other need and supply factors.One possible explanation is that the supply or quality of primary, community or social care for people with mental health problems is suboptimal in deprived areas.Although there is some evidence that inequity has reduced over time, the changes are small and not always robust to sensitivity analyses.
Affiliation: Centre for Health Economics, University of York, York YO10 5DD, United Kingdom. Electronic address: firstname.lastname@example.org.Show MeSH
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Mentions: Figs. 1 and 2 show the social gradient of SMI admission and how it has changed over time. Fig. 1 shows the SUR for each deprivation category in each of the five years. All lines are clearly upward-sloping, providing evidence that the equity of utilisation of SMI hospital care is pro-poor, and the relationships are remarkably consistent across years. (All but the lowest deprivation group have above-expected utilisation, and there is a concave relationship with each deprivation category associated with a smaller increase in utilisation. The appropriateness of this gradient depends on the social welfare function i.e. is a matter of the preferences of the stakeholders of the health care system; some might prefer a flat social gradient, although poorer patients are less likely to access private sector care. Given the wider social duty to promote equality that is enshrined in the NHS Constitution (see Introduction), a downward sloping social gradient would be cause for concern. Fig. 2 shows trends in the Standardised Utilisation Rate (rather than the ratio) by year and deprivation group, again showing a clear relationship between deprivation and standardised utilisation. The fall in utilisation in the last year of our sample is likely to be due to truncation, i.e. patients that had not finished their inpatient stay by the 31st of March 2011 and are therefore not recorded in our dataset. Trends are broadly parallel between groups, providing support for the assumption of constant relative need for SMI care across deprivation groups, i.e. need did not increase more rapidly for deprived patients compared with the rest of society.
Affiliation: Centre for Health Economics, University of York, York YO10 5DD, United Kingdom. Electronic address: email@example.com.