Research Proposal

An Analysis of Quality of Care in the Hierarchy

A. Rahman and P. Mellacheruvu

Introduction

Healthcare is the provision of medical and related services aimed at maintaining good health. The National Health Service (NHS) of the UK strives to provide healthcare from the top-down. In a nutshell, the NHS is the pinnacle of socialized medicine, as the British government pays almost any bill to the extent to which the maximum cost of receiving any prescribed medicine is a mere $12. The NHS was formed in 1948, in the wake of the atrocities of World War II. There was incredible opposition to the plan at the time, especially by the British Medical Association (BMA) stating that it was unsupportable and too ambitious. Today, some citizens of the UK have a similar opinion regarding NHS. Others believe that the NHS has done well, as Britain has a higher average life expectancy, lower infant mortality, and fewer medical and surgical mishaps. But how does this opinion vary among the classes? How related is quality of care with class structure in the UK? These are some of the questions that are to be explored on the ensuing analysis of how quality of care differs among the classes with NHS.

Research Questions

Considering the possible tensions in the healthcare system with respect to the class divisions of the UK, we began questioning how this system of care manifests itself. We wonder if there was a difference in the quality of care experienced by the different classes. Does it vary? Is the variance significant in any way? Considering this, how can we look at healthcare across classes? How can we take more recent immigration into account? To break down these questions even further, we began thinking about how quality of healthcare could possibly be measured. Importantly, we need to be able to somehow quantify quality in a way that is meaningful. We decided that an effective way to measure quality would be to measure time. What are the wait times for people in clinics that are public versus those which are private? Who frequents private clinics as opposed to private clinics? This led us to question the availability of difference clinics. How can we map the number of clinics in a geographical area, like Oxford, in relation to different demographic areas? Is there a correlation between the number of private and public clinics and property value? Also, how does the number of A&E’s factor in? Are they denser in certain locations as opposed to others? Who is more likely to use an A&E, and can this also be mapped and correlated with income distribution and/or property value? We feel that these are questions that we could possibly answer during our time at Oxford.

Methods

The overall approach to this project will be very hands on. A close attention will be on demographics and first-hand opinions of patients and physicians. With regards to demographics, the city of Oxford will be mapped by creating loose socioeconomic sectors of the city based on metrics such as property values. This data will be obtained from the Oxford City Council databases that are free to the public on the web and through other various real estate websites. Thus an analysis of the built environment is vital for the mapping process. Then the number of NHS clinics and private clinics for each sector can be counted. Then there will be a test to see whether there is a correlation between the socioeconomic sectors of the city and the ratio of NHS to private clinics in each sector. An offshoot of this process is the counting of the number of A&E departments in each sector. An A&E department is a clinic that accepts patients with accidents and emergencies requiring urgent care. Here, a similar ratio can be formulated with the A&E clinics. Finally, an integral aspect of the project is communicating with physicians and patients in the NHS clinics and private clinics. One day interviews can be conducted with willing participants at the NHS sponsored John Radcliffe Hospital and another day interviews can be conducted at private clinic: The Manor Hospital. Since there isn’t a way of quantifying “quality of care,” the interviews shed light on patient and physician experiences and opinions on NHS healthcare and private healthcare. Some examples of questions asked with include, “What are waiting times like for [x] procedure?” “How easy is it to pick and choose a particular hospital? A particular physician?” “What is the appointment scheduling process like? Time consuming or painless?” Even though only a small sample size of physicians and patients will speak for the system, through these questions one can get a gist for the overarching thoughts and opinions on the public vs. private sectors of healthcare in the United Kingdom.

Field Research Schedule

            While conducting our research, we will need to consult people, places, and many writer documents. Because they may be somewhat time consuming, we will need to set aside appropriate time to do interviews. Ideally we will be able to interviews the second week we are in Oxford, and we will need to include both doctors and patients. We are still working on figuring out which doctors and which hospitals and when, but hopefully we will be able to get a start on that soon. As for patients, we are looking to interview a few patients at a private clinic and a few at a public clinic. Ideally we will be able to pick patients who will be able to provide us with information we need in terms of wait times. We will need to probably take audio recordings with a device. We will also be able to assess the quality and differences between the clinics when we visit them to conduct interviews. It will be helpful to take pictures of these locations so that we can reference them in our research. We will also need to spend some time looking at maps of the Oxford area (including Oxfordshire). On these maps, we will have to locate all the public clinics, private clinics, and A&E’s. We will probably spend the first week doing this in order to get a feel for the places we will visit at the geographical relationship between the various clinics. We will also need to reference the demographics of the Oxford area and map them, possibly using property values. For this, we will need to utilize real estate information, likely through websites or by speaking to someone directly, for property values and other useful pieces of information. In order to set a basis for our understanding of class structure in the UK and the history of the NHS, we will also need to consult literature about these histories. Web sources will likely be the most helpful with this. Much of this part can be done before we even travel to the UK, and when we are there we can clarify things we hadn’t previously considered to be important to our understanding. If we decided to look into existing research about class and healthcare, we would also consult online publications and journals that contain papers about these topics. By the third week in Oxford, we should be able to analyze all the data we have collected and begin to compile it into a cohesive paper.

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