| Summary: | Equity of access to health care was the founding aim of the NHS and a recent White Paper on NHS reforms re-emphasised its importance. This thesis consists of two contrasting studies on equity of access using individual patients as units of analysis. The main objective of the first study was to examine the equity of access to primary care services including GP consultation, out-of-hour services and referral to specialist services. The study involved secondary analysis of patient questionnaire data from a national survey. The objectives of the second study were to examine the equity of access to coronary artery surgery in one health district among those who underwent coronary angiography, and to examine whether the waiting time for coronary artery surgery was correlated with clinical need. It involved retrospective collection of data from medical records using the New Zealand Priority scores as an indicator of need. The first study showed that the following patient groups subjectively experienced disadvantages in several aspects of primary care services:- younger people, those with poor subjective physical and mental health, females, non-whites, residents in Inner London and those in paid work or full-time education. The possible reasons for these findings were discussed. It was recommended that the delivery of primary care services should take into account these results and that further research should be conducted into the extent and nature of differential patient expectation amongst different patient groups. The second study did not show any significant inequity of access to coronary artery surgery according to sex, age, smoking status and socio-economic status. However, there was little correlation between clinical need and waiting time for coronary artery surgery. These results informed subsequent development of cardiology and cardiac surgery services in the health district. The methodologies used in these two studies were compared and contrasted.
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