Is publicly funded health care really distributed according to need? The example of cardiac rehabilitation in the UK.
OBJECTIVE
To demonstrate the importance of measuring both the horizontal and vertical components of equity in order to examine whether patients are receiving the health care that they need.


METHODS



METHODS
A theoretical demonstration followed by analysis of a prospectively collected national random sample of acute cardiac admissions to 94 hospitals in the UK.


METHODS
1064 patients under 70 years old.


METHODS
The association between use of cardiac rehabilitation and gender (after adjusting for clinical need) was measured using multivariable analysis with effect modification.


RESULTS
Hypertensive males were nearly twice as likely to undergo rehabilitation compared to hypertensive females (OR 1.76, 95% CI 1.03-3.02). Hyertensive patients were less likely to undergo rehabilitation than normotensive patients (OR 0.67, 95% CI 0.50-0.89) but this treatment difference did not apply in the same way to both men and women. Hypertensive women were half as likely to undergo rehabilitation compared with normotensive women (OR 0.48, 95% CI 0.30-0.78), whereas hypertensive men were as likely as normotensive men to receive rehabilitation (OR 1.00. 95% CI 0.63-1.60).


CONCLUSIONS
Horizontal inequity was demonstrated because male and female hypertensive patients with equal needs were not treated equally. There was also vertical inequity because although patients with hypertension were treated differently to normotensive patients, this treatment difference was not the same for men and women.
Raine
Rosalind
R
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. rosalind.raine@lshtm.ac.uk
Hutchings
Andrew
A
Black
Nick
N
D003324:Coronary Artery Disease / Q000534:rehabilitation*; D005260:Female; D006297:Health Services Accessibility; D006302:Health Services Research / Q000379:methods; D006779:Hospitals, Public / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D040841:Resource Allocation / Q000706:statistics & numerical data*; D012737:Sex Factors; D012935:Social Justice; D012959:Socioeconomic Factors; D013222:State Medicine / Q000191:economics / Q000592:standards; D006113:United Kingdom