illustration for the drivers of inequality

Driver Category 1.1

Lack of adequate resources for, and unequal access to, quality and timely healthcare

The lack of a universal, free at the point of use healthcare system is a major driver of health inequalities. This driver captures everything related to unequal levels of access to all health services (prevention, diagnosis, treatment services, access to new health technologies); all aspects of health policy, infrastructure, staffing, accessibility and affordability; the adequate nature of (preventative) public health programmes; equal access to high quality maternal and childcare and all health expenditure aspects that influence health and disease and mortality outcomes.

Aspects of state discrimination via health policy design and implementation are also captured by this driver category. The absence of the state in providing healthcare in certain contexts would also be included here if relevant. Any aspects that explain gaps in outcomes related to privatisation and the access to premium style health provision and the best treatments by the wealthy would also come out in analysis under this driver category. For example, this includes privileged access to better treatment through private health insurance, that can be a factor behind different treatment and outcomes for users of public health insurance systems vs private health insurance systems. Privileged access to private healthcare can also undermine public health systems through the privileged electorate not supporting necessary investment for provision and access to the best treatment within the public system.

It would also include how privatised healthcare impacts on the public health system (eg. in terms of competition for healthcare workers and any other impacts which contribute to deterioration of the public healthcare system).

Aspects of political capture that impact how health policy is developed and whether and how the sector is privatised is also be relevant here.

Guiding Questions

General questions

  • What is the state of debate about health inequalities within the health sector?
  • Are there efforts being made to push for more equitable health policy design and expenditures?
  • What is the state of debate within society on health inequalities?
  • Does the media report on problems with service provision for certain areas and groups?
  • Is the practice of paying fees for different health services growing or is public health insurance (or free coverage) being extended in scope?
  • Is public health insurance affordable and increasing in the coverage of care it offers?
  • Are there efforts to expand coverage of public health insurance to informal workers?

Health budget

  • What is the state of debate about health inequalities within the health sector?
  • What is the level of public expenditure on health - in absolute terms, as a share of GDP and as a share of total spending?
  • Is health spending increasing – including on a per capita basis - or is it under pressure?
  • Is there evidence that public investment in health takes into account inequalities between groups and locations?
  • Is the pattern of spending correcting for or worsening imbalances?

Health infrastructure and staffing

  • What is the state of debate about health inequalities within the health sector?
  • What is the assessment of the current state of health infrastructure?
  • Are there problems of staff retention or recruitment?
  • Are trained staff being poached by private health institutions?
  • Are trained staff taking up opportunities abroad?
  • Are health services geographically accessible in all areas?
  • Which locations have particular infrastructure gaps?

Health services for people with disabilities

  • What policies are in place in relation to the provision of primary and specialist healthcare services for people with complex or additional physical or mental healthcare needs?
  • Are health services for people with disabilities accessible and affordable?
  • Do health promotion and prevention activities adequately targeted people with disabilities?
  • What are the main challenges in this area?

Mental health services

  • Is adequate local provision in place to address evolving mental healthcare needs?
  • What are the main challenges for the mental health system?
  • What quality improvement strategies are in place?

Indicators

Potential indicators to monitor the drivers of inequalities in this main driver category

  • Out of pocket expenditures on health as % of income of different groups
  • % of national budget spent on health / % of GDP spent on health
  • Amount of health spending per capita (national and per region)
  • % of national health budget spent on primary, secondary and tertiary healthcare
  • Ratio of doctors/nurses/mid-wives/mental healthcare workers (and/or other key healthcare workers) to population (national and per region)
  • % of national health budget and amount spent on maternal and child health (key programmes)
  • Amount of time to reach a health facility (health post/clinic, GP, accident and emergency department) in different areas
  • Length of waiting times for different treatments in different areas
  • Coverage of public / private health insurance

Candidate Policies

To see related Candidate Policies in this main driver category please click here.