Reappraisal of the Inverse Care Law Conclusion & Bibliography

Overview of Study

The point of this study was to reconsider the Inverse Care Law and its relevance for today. Recent literature provides a strong case that the Inverse Care Law continues, however it also suggested that the effect of individuals’ social class was the source of this problem, rather than market forces which was proposed by Hart originally.

This research sought to test whether the source of the Inverse Care Law is located in the contextual factor of the deprivation level of the health services and the surrounding area, or whether this relationship is actually caused by the interpersonal relationships of patients and GPs, based on socioeconomic class. Secondary data was used from the National Survey of Local Health Services 2006 and analysed in SPSS in relation to socioeconomic status (measure by level of education), age group as a control, and high and low deprivation PCTs.

Overall Conclusions

The results were the opposite than expected for both socioeconomic class and age group, but as expected for PCT areas. The conclusions drawn from this are as follows:

  1. That higher expectations of higher resource groups and younger age groups are likely to have resulted in these groups being more critical and less satisfied with the service received, despite probably receiving the same service, or potentially even a better service than those of a lower socioeconomic background or older age.
  2. That age group appears to be a more significant factor than socioeconomic class in relation to the Inverse Care Law.
  3. That the marked difference between level of satisfaction in high and low deprivation groups suggests that the Inverse Care Law persists today despite policy initiatives.


Due to restrictions in gaining access to research the NHS this project had to rely solely on secondary data which in this case was wholly quantitative. Whilst this allowed for some useful statistical analysis and removed the possibility of researcher’s bias, the lack of qualitative data is to the detriment of this study, which was focused on experiences of health services – something perhaps better investigated through qualitative methods which would allow more insight into patient experience.

Whilst there was a good sized sample population of 10,000, the method of questionnaires relied on the self reporting of health care experiences, not accounting for the role of expectations which is likely to affect patient satisfaction, making the different socioeconomic and age groups incomparable in terms of the actual service received.

Further Research

Whilst it is not possible to suggest policies for health care reform based on this study, it does suggest the need for further research into the Inverse Care Law. To control for differences in expectations it would be useful to carry out observations of GP consultations, comparing both high and low deprivation PCT areas, high and low income groups and those in different age groups, to discern where the problem of the Inverse Care Law stems from.  The findings (that reinforced the literature review) of a continuation of marked difference in health care received in high and low deprivation areas is in itself enough to suggest that the Inverse Care Law persists despite efforts in policy and that further research is necessary before the problem can be solved.

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