International evidence suggests that there are substantial socio-economic inequalities in the delivery of specialist health services, even in the UK and other high-income countries with publicly funded health systems (Goddard and Smith 2001, Dixon et al. 2003, Van Doorslaer, Koolman and Jones...

Increasing evidence shows that hospital competition under fixed prices can improve quality and reduce cost. Concerns remain, however, that competition may undermine socio-economic equity in the utilisation of care. We test this hypothesis in the context of the pro-competition reforms of the...

This study developed a method for measuring change in socio-economic equity in health care utilisation using small area level administrative data. Our method provides more detailed information on utilisation than survey data but only examines socio-economic differences between neighbourhoods...

The National Institute for Health and Clinical Excellence (NICE) routinely publishes details of the evidence and reasoning underpinning its recommendations, including its social value judgements. To date, however, NICE?s social value judgements relating to equity in the distribution of health...

Distributional cost-effectiveness analysis (DCEA) is a framework for incorporating health inequality concerns into the economic evaluation of health sector interventions. In this tutorial we describe the technical details of how to conduct DCEA, using an illustrative example comparing...

Aim is to estimate the NHS cost per case of the legal declaratory relief process in relation to withdrawal of clinically assisted nutrition and hydration (CANH) from patients diagnosed as being in a permanent vegetative state (PVS), in relatively ‘straightforward’ cases where family...

This paper presents a case study application of a new methodological framework for undertaking distributional cost-effectiveness analysis (DCEA) to combine the objectives of maximising health and minimising unfair variation in health when evaluating population health interventions. The NHS Bowel...