Report 12/2015
General practice funding underpins the persistence of the inverse care law: cross-sectional study in Scotland by Gary McLean, Bruce Guthrie, Stewart Mercer, Graham Watt

General practice funding underpins the persistence of the inverse care law: cross-sectional study in Scotland

Summary

About this report

This report argues that, although the principal social determinants of health operate outside health care, health care can mitigate the effects of poor health, by reducing the severity and delaying the progression of conditions.

And says that: whether health care reduces or increases health inequalities depends on the extent to which it is delivered in proportion to need across the socioeconomic spectrum.

Universal healthcare coverage provides access to care, but does not in itself equip front-line practitioners to respond proportionately to patients’ clinical needs. On average, GPs in more deprived areas have a higher workload, with more consultations with patients who are more likely to be multimorbid with both physical and mental conditions, but do not receive additional funding to address these complex needs.

When needs are partially met, the heath service underachieves in reducing the severity and slowing the progression of health and social problems.

Until allocation formulas in Scotland and the rest of the UK take into account the earlier onset of morbidity in more deprived areas and the wide deprivation-related differences in multimorbidity and chronic illness between age groups, such funding systems will remain inequitable, and continue to be part of the problem of health inequalities, rather than part of the solution.