Socioeconomic Status and Wait Times in Europe

[phk]

http://healthcare-economist.com/

Socioeconomic Status and Wait Times in Europe

December 17, 2009 in Health Care Around the World, Wait Times

One of the most contentious parts of the healthcare debate in the U.S. is whether or not to move towards a more European style of health care.  Those in favor cite the equality of the system, the lower cost, and lower administrative cost.  Those against rail against the lack of provider choice and the long wait times for many specialist services (see graphic).

But do all people in Europe experience the same waiting period for medical care?  A paper by Sicilliani and Verzulli (2009) find that individuals with higher socioeconomic status have shorter wait times in Europe.

“…individuals with high education experience a reduction in waiting times of 68% in Spain, 67% in Italy and 34% in France (compared with individuals with low education). Individuals with intermediate education report a waiting-time reduction of 74% in Greece (compared with individuals with low education). There is also evidence of a negative and significant association between education and waiting times for non-emergency surgery in Denmark, the Netherlands and Sweden.”

However, the authors don’t attempt to explain why individuals with higher socioeconomic status have shorter wait times.  Here are some explanations I came up with:

    * Private health insurance spillovers.  Let us assume that the government allocates healthcare resources on a per person basis.  Also assume that wealthier individuals are more likely to buy private health insurance.  If this is the case, wealthy/educated individuals living in “better” neighborhoods will experience shorter waits at the government run health centers because many of their neighbors will be using privately supplied medical services.

    * Buying votes.  The government may allocate more healthcare dollars to neighborhoods with wealthier individuals.  Politicians may do this to court the votes (and donation dollars) of the wealthier voters.

    * Tiebout sorting.  Let us assume that healthcare quality is randomly distributed geographically.  Property values will increase in areas with better public health facilities.  The people who can afford homes/rents in these high-quality healthcare neighborhoods will naturally be those who can afford it (i.e., those with higher socioeconomic status.)

    * Personal connection.  Physicians have high socioeconomic status and are more likely to be friends with patients who have high socioeconomic status.  Thus, they may be doing favors for their friends by getting them in earlier.  This likely happens, but does not explain the large disparities Sicilliani and Verzulli find.

    * Rich people complain.  If more educated individuals are more likely to complain about long wait times, physicians may have an incentive to schedule them first.

    * Bribes.

Any others?

[Franzl]

This isn't (entirely) wrong.

But let me ask you this: If you're a poor fat guy from Alabama, would you rather be put on a waiting list or not have any care at all?

[dead0man]

But let me ask you this: If you're a poor fat guy from Alabama,

Move and go on a diet

[opebo]

But let me ask you this: If you're a poor fat guy from Alabama,

Move and go on a diet

Too late already dead.

And any way even if you are living in a high-cost city and have a lean BMI, you will still not be able to afford health care, and will still get cancer or some other horrible disease.  This is life, deadman, and there's nothing you can do about it.

[dead0man]

Yep, no skinny people in expensive cities have health care and they all will die of cancer or other horrible diseases.

[opebo]

Yep, no skinny people in expensive cities have health care and they all will die of cancer or other horrible diseases.

The point is some will and they have no control over it.