THEORY AND METHODS An alternative approach to quantifying and addressing inequity in healthcare provision: access to surgery for lung cancer in the east of England

Study objective: Equitable access to healthcare services should be monitored routinely. This study compares provision of surgery for non-small cell lung cancer in the east of England with incidence of nonsmall cell lung cancer. In addition to conventional comparisons, process control charts are used to identify areas in which access seems to be significantly different from average. Design: Ecological comparison of surgery rates for non-small cell lung cancer between 1998 and 2000 and incidence of non-small cell lung cancer over the same time period. Setting: Population of Norfolk, Suffolk, Cambridgeshire. Participants: The denominator was the resident population. Numerators were 4092 deaths from non-small cell lung cancer and 387 surgical procedures for lung cancer. Main results: Incidence of non-small cell lung cancer by primary care trust (PCT) does not correlate with surgical procedure rate, in men r=0.37 (95% confidence intervals 20.14 to 0.72), in women r=0.07 (95% confidence intervals 20.43 to 0.53). Control charts indicate that the surgery rate is significantly different from average in three PCTs, high in one and low in two others. The optimum surgery rate is unclear but raising it from 9% to a theoretical level of 15% would mean no PCTs have above average rates while six PCTs have rates that are significantly low. Conclusions: There does not seem to be equity of access to surgery for patients with non-small cell lung cancer in the east of England. Control charts can help both to identify areas where access is particularly high or low, and also to monitor performance against a theoretical optimum surgery rate.