New research from the University of Bristol shows that wealthier people are likely to travel further than poorer people do for elective care.

Professor Carol Propper of the Centre for Market and Public Organisation (CMPO) and colleagues, writing in the summer issue of Research in Public Policy, explains that the new ‘choose and book’ system – whereby all patients can choose any provider of hospital care by 2008 – will exacerbate class differences.

Professor Propper says, ‘The evidence from our research suggests that, without policy effort to overcome biases, the "choose and book" system will perpetuate existing differences between rich and poor. At the very least, GPs in less affluent areas are going to have to be more pro-active in encouraging choice than their counterparts in practices in more leafy suburbs. And perhaps there will need to be a scheme that helps poorer individuals with travel costs.’

The researchers from CMPO and the King’s Fund examined which people are most likely to exercise choice by analysing the travel patterns of people admitted to hospital for in-patient or day care in the NHS in 2003-04. Although this was just before the ‘choice agenda’ began, the pattern of hospital location has not changed dramatically so the results offer a reasonable guide to likely future outcomes.

The research shows that there is a large difference between what are termed ‘long-distance travellers’ – the 10% of people who travel furthest. In affluent areas, these people travel around 40km for their elective care; the comparable distance for those who live in the most deprived areas is below 20km.

One possible explanation is that the middle classes are more likely to get their GPs to refer them to better hospitals and some of these are located further away than those GPs normally choose for their patients. Another possible explanation is that poorer people are offered care outside their local areas, but turn it down because they cannot afford the travel costs.

The other key findings of the research are that:

• The distances travelled by all people are quite long. The average distance travelled for elective care is just over 17km and only slightly less for emergency care.

• Within this average, there are some important differences. People in rural areas travel considerably further than those in urban areas: on average, the former travel just over 27km for elective care while the latter travel only 15km. This is as might be expected: more hospitals are located in urban areas than in rural areas.

• Children often travel further than adults for their care. The average distance travelled by someone under 18 is around 20km while the average distance travelled by someone over 65 is closer to 10km. And some children make very long journeys: around one child in every 10 travels 50km or so.

• The differences between children and adults probably reflect the location of facilities: there are fewer specialist children’s hospitals than hospitals that provide hip and knee replacements and treatment for cataracts, all of which are used disproportionately by older people. So the location of hospitals means that elderly people will travel less far for their care.