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April 20, 2005

Health Vulnerability

JAMA. 2005;293(15):1924-1925. doi:10.1001/jama.293.15.1924

Those with the greatest health needs often receive the least adequate health care. This truism has been termed “the inverse care law”1 and the “treatment-risk paradox.”2 There are several explanations for it. Market economies tend to allocate resources, including health care, based on means rather than needs. Impoverished children and families with the greatest needs typically access the least resources whether they are related to nutrition, child care, education, employment, or health care. While lower socioeconomic status is powerfully associated with worse health, physicians and hospitals tend to migrate toward more affluent communities and serve better paying, but less needy, patients. National health insurance helps, but the inverse care law persists, even under a national health service.3

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