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Electronic letters to:

Research:
Eddy van Doorslaer, Cristina Masseria, Xander Koolman for the OECD Health Equity Research Group
Inequalities in access to medical care by income in developed countries
CMAJ 2006; 174: 177-183 [Abstract] [Full text] [PDF]
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Electronic letters published:

[Read eLetter] Specialist care favours the rich?
Andrew Robinson   (23 January 2006)

Specialist care favours the rich? 23 January 2006
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Andrew Robinson,
516 Moonrock Ave
Sudbury Regional Hospital

Send letter to journal:
Re: Specialist care favours the rich?

mathesonian{at}hotmail.com Andrew Robinson

While the title is interesting, two conclusions could be reached, the first is that the rich favour specialists, and the second would be that specialists favour the rich. What isn't clear, is whether the outcomes, in terms of health, are any different.

For example, in the latest issue of the Journal of Clinical Oncology, it was shown that specialist follow up and generalist follow-up were equivalent in terms of breast cancer outcomes. The specialist, however, would charge twice as much for a follow-up appointment, and if the user was paying, then the rich would go to the specialist, the poor to the generalist, with no difference in outcomes.

An inequality in access to care doesn't necessarily affect outcomes, just as an inequality in access to expensive vehicles doesn't affect the propensity to crash a car. While one could make the argument that rich patients in free market countries do better by seeing specialists, one could make the counter argument that specialists in free market countries do better by seeing rich people.

Conflict of Interest:

None declared