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dc.contributor.authorAsthana, Sheena
dc.contributor.authorGibson, Alexander
dc.date.accessioned2018-11-26T12:15:56Z
dc.date.issued2018-08-02
dc.identifier.issn1744-1331
dc.identifier.urihttp://hdl.handle.net/10026.1/12887
dc.description.abstract

Explanations of the state of ‘crisis’ in the English National Health Service (NHS) generally focus on the overall level of health care funding rather than the way in which funding is distributed. Describing systematic patterns in the way different areas are experiencing crisis, this paper suggests that NHS organisations in older, rural and particularly coastal areas are more likely to be ‘failing’ and that this is due to the historic underfunding of such areas. This partly reflects methodological and technical shortcomings in NHS resource allocation formulae. It is also the outcome of a philosophical shift from horizontal (equal access for equal needs) to vertical (unequal access to equalise health outcomes) principles of equity. Insofar as health inequalities are determined by factors well beyond health care, we argue that this is an ineffective approach to addressing health inequalities. Moreover, it sacrifices equity in access to health care by failing to adequately fund the health care needs of older populations. The prioritisation of vertical over horizontal equity also conflicts with public perspectives on the NHS. Against this background, we ask whether the time has come to reassert the moral and philosophical case for the principle of equal access for equal health care need.

dc.language.isoen
dc.publisherCambridge University Press (CUP)
dc.titleThe National Health Service (NHS) in 'crisis': the role played by a shift from horizontal to vertical principles of equity
dc.typejournal-article
plymouth.journalHealth Economics, Policy and Law
dc.identifier.doi10.1017/S1744133118000361
plymouth.organisational-group/Plymouth
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA20 Social Work and Social Policy
plymouth.organisational-group/Plymouth/Research Groups
plymouth.organisational-group/Plymouth/Research Groups/FoH - Community and Primary Care
plymouth.organisational-group/Plymouth/Research Groups/Institute of Health and Community
plymouth.organisational-group/Plymouth/Users by role
plymouth.organisational-group/Plymouth/Users by role/Academics
dcterms.dateAccepted2018-06-13
dc.rights.embargodate2018-12-14
dc.rights.embargoperiodNot known
rioxxterms.versionofrecord10.1017/S1744133118000361
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2018-08-02
rioxxterms.typeJournal Article/Review


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