4.2.3.3 Inequalities in provision of and access to health care Quiz: AQA Sociology, Unit 2

The 20 questions

1. What is meant by the term 'postcode lottery' in relation to health care?

   • A method of ranking hospitals by the average postcode of the patients they treat in each financial year
   • A policy in which health authorities pay GP practices according to the number of postcodes they serve
   • Patients in different areas receiving different access to services or treatments, depending on where they live
   • A system in which patients are allocated treatment at random by a computer, regardless of their clinical need

2. How is the NHS primarily funded?

   • Mainly through a payment made by each patient at every consultation, with the state paying only for children
   • Mainly through charitable donations from the public and from private companies, with no tax contribution
   • Mainly through private insurance premiums paid by individuals, with the state providing only emergency services
   • Mainly through general taxation, with services free at the point of use

3. In sociology, what is meant by 'access' to health care?

   • The legal right of every citizen to a private consultation with any doctor they choose, at any time of their choosing
   • The ability of different groups to obtain and use health services when they need them
   • The number of hospital buildings a region has, regardless of how many people use them or can afford to reach them
   • The total budget spent on health care by government, which is the only measure of how well services are provided

4. Which term describes the introduction of an internal market into the NHS, with providers competing for contracts from purchasers?

   • Collectivisation, meaning the transfer of all private hospitals to direct state control and public ownership
   • Marketisation
   • Corporatism, meaning the close cooperation between government, employers and unions in setting health policy
   • Universalism, meaning the provision of services to all citizens on the same basis, regardless of their income

5. Which sociologist's work on blood donation argued that commercial markets can weaken altruism and social solidarity?

   • Michel Foucault, who analysed the medical gaze and the relationship between knowledge and power
   • Ivan Illich, who argued that medicalisation expands professional control over everyday life
   • Talcott Parsons, who developed the sick role to explain the rights and obligations of patients
   • Richard Titmuss, in The Gift Relationship

6. What is 'rationing' in the context of health care provision?

   • The transfer of patients between hospitals so that each hospital has the same number of beds at all times
   • The explicit or implicit limiting of treatments by priority, cost or other criteria, so that demand exceeds available resources
   • The provision of an equal amount of treatment to every patient, regardless of severity, need or the resources the service has available
   • The free distribution of medicines to all patients, funded entirely by charitable donations from the public

7. Which concept describes the way that a person's ability to pay can determine how quickly they receive a service within a mixed public and private system?

   • A residual system in which only the poorest are treated, so that payment is not relevant to the order of care
   • A single-tier system in which every patient is charged the same fee, so that payment has no effect on waiting times
   • A two-tier system of access in which those who pay privately can bypass waiting lists for NHS care
   • A universal system in which every patient receives identical care, so that payment has no influence on access

8. Which of these is an example of implicit rather than explicit rationing of health care?

   • Clear national criteria stating which age groups are eligible for a particular screening programme, published in advance
   • A formal decision that a drug will be funded only if it meets a set cost-effectiveness threshold, applied to every patient equally
   • Patients being left on long waiting lists for non-urgent surgery, with no published eligibility criteria explaining the delay
   • A published list of treatments that a local health body will not fund for patients with certain conditions, with reasons given

9. A GP practice has 9,000 registered patients and 3 full-time GPs. How many patients does each full-time GP have on average?

   • 3,000 patients per GP
   • 27,000 patients per GP
   • 4,500 patients per GP
   • 2,000 patients per GP

10. What does a 'user charge' or 'co-payment' in health care refer to?

    • A fee paid to a health professional for writing a report, which is always met in full by the individual patient
    • A charge paid by the patient at the point of use for a service that is otherwise publicly funded
    • A payment made by the government to private hospitals for each patient they treat on behalf of the public system
    • A contribution made by employers into a central fund that pays for the health care of their own staff

11. Which factor best explains why people living in rural areas may face greater barriers to specialist care?

    • Higher levels of clinical need in rural areas, which means specialist care is never needed in urban areas
    • Greater travel distances and fewer specialist services available locally
    • A preference among rural residents for general practice only, which means they never request specialist care
    • A legal ban on specialist services in rural areas, which is enforced by national health regulators

12. Which policy would most directly reduce the postcode lottery in access to treatment?

    • Increasing private hospital capacity only in wealthy areas, so that the overall number of beds in the country rises
    • Charging every patient a fee for each GP visit, so that patients take more responsibility for their use of services
    • Removing all national targets for waiting times, so that each local area can set its own priorities and budgets
    • National standards and funding formulae that allocate resources according to the health needs of each population

13. A patient cannot register with a GP because they cannot provide proof of a fixed address. Which type of barrier to access is this?

    • A clinical barrier, arising from a medical condition that stops the patient attending any appointment at all
    • A cultural barrier, arising from a patient's belief that doctors should never be consulted for any reason
    • A financial barrier, arising from a patient's inability to pay the full cost of a consultation with a GP
    • An administrative barrier to registration

14. Why might a woman with caring responsibilities find it harder to attend regular health appointments?

    • Carers are always paid for their time by the NHS, so they have no financial reason to limit their attendance
    • Carers are always in better health than others, so they have no need for regular appointments with any professional
    • Caring duties can limit the time available for appointments and the travel needed to reach services
    • Carers are legally barred from attending any health appointments, so they are referred to private services automatically

15. Evaluate whether marketisation improves access to health care for all groups.

    • Marketisation guarantees equal access for every group, because competition ensures that every patient is treated identically
    • Competition may improve efficiency for some, but it can increase inequality by favouring those who can choose providers or pay
    • Marketisation improves access only for the poorest groups, because providers compete to attract those with lowest incomes
    • Marketisation has no effect on access, because the level of government funding is the only factor that matters

16. Which argument for a universal, tax-funded health service is most consistent with Titmuss's work?

    • Universal systems are cheaper in every case because they avoid all spending on specialist and hospital services
    • Universal systems make patients less responsible for their health, so they reduce the need for any personal care at all
    • Universal systems remove all incentives for medical innovation, so they maximise the speed at which new treatments are invented
    • Universal systems can build social solidarity and reduce the unequal access that markets tend to produce

17. Two areas have the same level of need. Area A has two hospitals and a 4-week waiting time, while area B has one hospital and a 12-week waiting time. Which conclusion is best supported?

    • Hospital capacity appears to affect waiting times, but staffing, demand and other factors may also play a part
    • Waiting times are determined entirely by hospital numbers, so staffing and demand have no effect on waiting at all
    • Area B has a lower need for treatment, which explains its longer waiting time without reference to hospital capacity
    • Area A has better health outcomes by definition, because a shorter waiting time always shows a healthier population

18. Which is a limitation of using waiting times as a measure of access to health care?

    • Waiting times do not capture people who never join a list or who give up before receiving treatment
    • Waiting times can be measured only in days, so they cannot show any differences between hospitals or regions
    • Waiting times are always recorded accurately by every hospital, so they cannot be affected by reporting practices
    • Waiting times are the same as clinical outcomes, so they show whether patients have recovered from their illness

19. Why do sociologists treat waiting times for elective surgery as a possible indicator of inequality?

    • Patients with similar need can wait very different lengths of time depending on class, area or ability to pay
    • Waiting times depend only on how quickly each patient recovers, which is set by biology and does not vary with social position
    • Waiting lists are kept secret from patients, so their length cannot be measured by any independent research or audit
    • Long waiting times show that every patient receives identical treatment, with no differences in priority or access at all

20. Which factors are most often linked to low take-up of NHS dental care among low-income adults?

    • Dental care being free for all adults in the UK, so that low take-up reflects only a lack of interest in oral health
    • Charges for treatment and few NHS dentists accepting new patients in deprived areas
    • Patients' preference for private dental clinics, which surveys identify as the main reason that NHS dental services are underused
    • A belief among every income group that dental care is unnecessary for adults, which is equally common across all areas of Britain

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