Inverse care law

The Inverse Care Law
Julian Tudor Hart
The Lancet 7696, 405-412 (1971)
Redistribution of general practitioners in the early years of the NHS for
two reasons:
Inducement payments and area classifications with restricted
entry to over-doctored areas.
Lack of posts in hospital and general practice, so many doctors
took the only positions open to them, bringing new standards of
The Inverse Care Law
The availability of good medical care tends to vary inversely with the
need for it in the population served.
The inverse care law operates more completely where medical care is
most exposed to market forces.
Doctors are (often) highly literate
Less knowledgeable about mathematics
Glamorgan and Monmouthshire 1968
Standardised mortality from all causes = 131% of England Wales rate
Weighted mean infant mortality = 124% of England and Wales Rate
A just and rational distribution of the resources of medical care should
show parallel social and geographical differences, or at least a uniform
England 27 347 GPs
Population 53 million
Salford 150 GPs
Population 215 000
1938 patients / GP on average in England
1433 patients / GP on average in Salford
Wales 1940 GPs
Population 3 000 000
1546 patients / GP on average in Wales
Market forces 1
Industrial practices
Small profits with a large turnover
Patients each paying a small sum for a consultation
Doctors developed the ability to give an accurate diagnosis on the
minimum of evidence
Market Forces 2
Two tier health service
Majority of care is fee paying / insurance based
Medical care is a quantity that should be bought and sold
like any other.
Upper limit of direct taxation has been reached
What constitutes good medical care?
Universal availability of health centres
Better care means to see patients less often and in greater depth
His unifying theme has been the application of Marxist philosophy
to primary health care.

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