Equity in Health Service Use by Children: Examining the Ethnic Paradox

Abstract

This article investigates whether equity is achieved in health service utilisation by children and young people aged 0–19 years. Data from the British General Household Survey 1991–4 is used to examine the influence of ethnicity, along with social class, housing tenure, family structure and employment of parents on the use of general practitioner, outpatient and inpatient services. Health status is the most powerful predictor of use for each health service and there is no evidence of socioeconomic inequalities. However, a clear ‘ethnic paradox’ persists after controlling for socioeconomic and demographic factors. South Asian children have a higher utilisation of GP services than any other ethnic group, but the use of hospital services is lower for children in all minority ethnic groups relative to the white population. Possible explanations for this paradox are examined in relation to indirect indicators of service quality. There is no evidence to suggest that South Asian children visit the doctor more frequently for a given illness episode than white children, but having a non-UK- born mother is associated with increased consultation and reduced use of outpatient services relative to UK-born South Asian parents.