The role of income and race/ethnicity in experiences with medical care in the United States and United Kingdom

Int J Health Serv. 2008;38(4):671-95. doi: 10.2190/HS.38.4.f.


Inequalities in experiences with medical care are well-known in the United States, but little is known about the shape of such inequalities in other countries. This study compares a broad spectrum of experiences in the United States and United Kingdom. Furthermore, it focuses on two of the most important dimensions of inequality, race/ethnicity and income, and two of the most widely discussed system-level factors, health insurance and emphasis on primary care. Two general conclusions are reached. First, there are broad income-based inequalities in medical care in both the United States and United Kingdom. These inequalities persist even after controlling for health insurance, including private medical insurance in the United Kingdom. Race is also related to experiences with medical care, although the effects of race are more particular and contingent than are those for income. In particular, the mapping of racial/ethnic inequality differs considerably between the United States and United Kingdom, reflecting their different sociocultural climates. Second, the health care system, especially primary care, plays a limited role in ameliorating inequalities in care, but plays a strong role in elevating the average level of quality within a country. Because inequalities in medical care reflect broader social processes, they are durable across very different health care systems and contexts.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • African Continental Ancestry Group
  • Asian Continental Ancestry Group
  • Continental Population Groups / psychology*
  • Continuity of Patient Care
  • Cross-Cultural Comparison
  • Ethnic Groups / psychology*
  • European Continental Ancestry Group
  • Health Care Surveys*
  • Health Services Accessibility
  • Healthcare Disparities / economics*
  • Hispanic Americans
  • Humans
  • Income / statistics & numerical data
  • Insurance Coverage / statistics & numerical data
  • Models, Econometric
  • Patient Satisfaction / economics*
  • Patient Satisfaction / ethnology*
  • Primary Health Care / economics*
  • Primary Health Care / standards*
  • Quality of Health Care*
  • State Medicine / economics
  • State Medicine / standards
  • United Kingdom
  • United States