title: Horizontal inequality in rationing by waiting lists.
abstract: The objective of this article was to investigate the existence of horizontal inequality in access to care for six categories of elective surgery in a publicly funded system, when care is rationed through waiting lists. Administrative waiting time data on all elective surgeries (n = 4,634) performed in Ostergötland, Sweden, in 2007 were linked to national registers containing variables on socioeconomic indicators. Using multiple regression, we tested five hypotheses reflecting that more resourceful groups receive priority when rationing by waiting lists. Low disposable household income predicted longer waiting times for orthopedic surgery (27%, p < 0.01) and general surgery (34%, p < 0.05). However, no significant differences on the basis of ethnicity and gender were detected. A particularly noteworthy finding was that disposable household income appeared to be an increasingly influential factor when the waiting times were longer. Our findings reveal horizontal inequalities in access to elective surgeries, but only to a limited extent. Whether this is good or bad depends on one's moral inclination. From a policymaker's perspective, it is nevertheless important to recognize that horizontal inequalities arise even though care is not rationed through ability to pay.
authors.forename: Gustav
authors.initials: G
authors.lastname: Tinghög
authors.forename: David
authors.initials: D
authors.lastname: Andersson
authors.forename: Petter
authors.initials: P
authors.lastname: Tinghög
authors.forename: Carl Hampus
authors.initials: CH
authors.lastname: Lyttkens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D013222:State Medicine; D013548:Sweden; D014850:Waiting Lists; D055815:Young Adult