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: 1. Inducement payments and area classifications with restricted entry to over-doctored areas. 2. Lack of posts in hospital and general practice, so many doctors took the only positions open to them, bringing new standards of care. 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 distribution 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 Seale: Two tier health service Majority of care is fee paying / insurance based Lees: Medical care is a quantity that should be bought and sold like any other. Crossman: 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 www.juliantudorhart.org His unifying theme has been the application of Marxist philosophy to primary health care.