Scoping review reveals factors behind inequality in access to healthcare

A scoping review of UK and international evidence by the Evidence Service at Public Health Wales has aimed to identify which population groups experience inequalities and face barriers when accessing healthcare. 

The scoping review identified inequalities in access to healthcare across seven population characteristics. These were age, level of education, ethnicity or immigration status, gender, medical and lifestyle risks, rurality and social deprivation; and socioeconomic status.  

The scoping review also found that the direction of the inequalities varied by the type of healthcare service or setting being accessed. For example, when compared with younger age groups, the evidence identified suggested that over 65’s were more likely to access certain health services such as the NHS Health Check, but less likely to utilise certain specialist services such as cardiovascular care and diabetes care. 

Several barriers contributing to the inequalities in access to healthcare services were also identified. These were predominantly reported amongst ethnic minority populations, migrant populations, and older adults; and mainly comprised of factors relating to accessibility and affordability of the healthcare services.  

The factors impacting the accessibility of the healthcare services included a lack of understanding of local healthcare services and entitlement; lack of culturally appropriate services; digital exclusion; and geographical inaccessibility. 

Direct and indirect financial barriers relating to the affordability of a healthcare service identified included time and cost of travel, the requirement to take time off work, sourcing childcare provision, or competing priorities like family commitments. 

Additionally, several barriers specific to healthcare providers were identified that contributed to inequalities in access to specific healthcare services by different population characteristics. These include lack of cultural understanding reported by Gypsy, Roma and traveller communities and migrant populations; lack of resource allocation reported by ethnic minority groups and migrant populations; refusal of service reported by sexual minority women; as well as lack of understanding and knowledge relating to gender and sexually diverse young people reported by marginalised young people. 

Amy Hookway, Principal Evidence and Knowledge Analyst for the Evidence Service at Public Health Wales, said:

“The brief for this report was to conduct a broad scoping search for reviews produced using systematic methodology to identify the population characteristics who are less likely to access health services.   

“The scoping review has been able to provide an overview of the complicated picture of which groups experience inequalities in access to healthcare across different services.  

“The review provides policy makers with a baseline from which to develop further research, including that which is specific to groups in Wales.” 

 Inequalities in access to healthcare services: Agile Scoping Report (PDF, 1.0Mb)