HEALTH ECONOMICS Health Econ. 14: 391–406 (2005) Published online 23 February 2005 in Wiley InterScience (www.interscience.wiley.com). DOI:10.1002/hec.978 EQUITY IN HEALTH CARE Access to health care resources in the UK: the case of care for arthritis Carol Propper a,b, *, Jenny Eachus c , Philip Chan c , Nicky Pearson c and George Davey Smith c a Department of Economics and CMPO, University of Bristol, Bristol, UK b CASE, London School of Economics, London, UK c Department of Social Medicine, University of Bristol, Bristol, UK Summary The paper uses new and detailed data from a population sample of individuals with arthritis to examine the impact of objective measures of need for treatment and individual measures of socio-economic position on the distribution of public and private health care. The quality of the data and the range of explanatory factors are more detailed than previously used to study of the allocation of NHS care. The results indicate that broadly the NHS appears to meet its equity goal of equal care for equal medical need, though there is evidence that education increases the amount of resources received. The results also show the importance of the interaction between the public and private sectors in the UK. Copyright # 2005 John Wiley & Sons, Ltd. JEL classification: I11 Keywords equity in allocation of health care; NHS; arthritis; public and private health care Introduction Around 85% of UK health care is financed from the public purse. An aim of such tax finance is that payment for public health care should be separate from access to care, and access determined by medical need rather than ability to pay. Fifty years after the inception of the NHS support for this goal remains strong. Nevertheless there is con- siderable controversy as to whether the NHS achieves this delivery goal. It is clear that making health care free at the point of demand does not remove inequalities in health [1]. Evidence on whether, conditional on health status, the NHS delivers equal treatment is more mixed. Studies of patients with specific conditions, and from small- scale studies of the practices of doctors in hospital and community settings, suggests that individuals with access to fewer resources get less NHS care. But this is contradicted by analyses of large-scale household surveys which show conditional on medical need levels of NHS care do not depend on ability to pay [2]. This contradiction in findings is puzzling: if there is inequality of treatment at the micro level why does it not manifest itself at the more macro level of household surveys? One answer would be that pro-rich inequalities in treatment in some areas are balanced by pro-poor inequal- ities in other types of treatment, but as there is little evidence from the small-scale studies of the latter this seems unlikely. The answer is far more likely to rest in the differences in the type Copyright # 2005 John Wiley & Sons, Ltd. Received 1 June 2000 Accepted 19 August 2004 *Correspondence to: Department of Economics and CMPO, University of Bristol, 8 Woodland Road, Bristol BS8 1TN, UK. E-mail: carol.propper@bristol.ac.uk