‘Come and Get it’: Distributional Biases in Social Service Delivery Systems

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Abstract
In examining patterns of utilization of medical and paramedical services by the Australian elderly, Gibson (1983) made an interesting, counterintuitive discovery. While it is only to be expected that a person’s income should constitute a barrier to service utilization, it was somewhat surprising to find that barrier persisting even when services were publicly-funded. Even more surprisingly, that barrier seemed to persist for publicly-funded, publicly-provided services but to disappear for services which were publicly-funded but privately-provided. That finding runs counter to our ordinary expectations. After all, it is the private market in which income has the most direct role in rendering people’s desires into ‘effective demand’. Whatever impact income has on the delivery of goods and services from the public sector must surely be less direct, and therefore presumably less strong. Yet paradoxically, where service utilization is concerned, low income seems to be a hindrance in the public sector but not in the publicly-funded private sector. This essay offers a general theory aimed at dissolving that paradox. While it is essentially a theoretical exercise, our analysis does turn crucially at several points on empirical speculations that will ultimately require far more testing in far more countries and far more policy contexts.

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