Inequalities in the provision of and access to health care P2

Mark scheme, including the levels grid and indicative content

Examiner's comment

The nature of these questions means that students cannot rely on reciting knowledge. Questions will ask them to bring together aspects of their sociological knowledge in ways they have not done before. It is therefore important for students to allow time to think about how to answer the question. Students should be aware that there are two types of ten-mark questions. These have different requirements and different mark schemes. There are different marks available for the assessment objectives. 10 mark “outline and explain” questions have more marks available for knowledge and understanding, and none for evaluation. Introductions and conclusions are not required for 10-mark questions, are unlikely to help students and take up time. It is helpful if answers are set out to clearly indicate the two answers, with wording such as “One way/reason is…” or by starting a new paragraph for the second point. Answers that give more than two answers are unlikely to develop two of them sufficiently. The most successful answers to 10-mark questions were focused, clearly stating a point that addressed the question and then developing it, using sociological concepts, evidence such as an example and, where appropriate, theory. Students generally chose to interpret this question by focusing on access to health care and how this affected the distribution of health chances. The idea that more affluent individuals resided in places with better health care provision was a common way to do this and the inverse care law frequently featured.

Notes from the mark scheme and report

• must link medicine (consumer choice, private treatment, postcode availability) to the social distribution of health chances
• drift into health chances in general = 1–3
• most answered through access to care and the inverse care law

Mark scheme, including the levels grid and indicative content

Examiner's comment

On the 10-mark 'outline and explain' question (the fourth question in each topic area), and the 6-mark 'outline three...' question (the third question in each topic). For the 10-mark 'outline and explain' questions, students would benefit from clearly identifying a specific way, reason, or factor, followed by a developed explanation. This approach would help make their answers more coherent, structured and easier to reward. This question proved to be difficult for students. The expected responses were ideas such as the working class having a more fatalistic attitudes to life and therefore choosing to ignore medical advice. Instead, most students focused not on the “advice take” up part of the question but more general issues of access to health care. As a result, many of these answers were not well applied to the question and struggled to gain credit. Better responses focused on themes of understanding advice, material factors influencing the ability to act on the advice and so on.

Notes from the mark scheme and report

• about take-up of preventive ADVICE by class
• examples: middle-class confidence with doctors, cultural capital, work commitments and transport, health knowledge, material limits on diet/exercise, working-class fatalism
• most drifted into general access to health care and gained little
• general accounts of class health differences = 1-3

Mark scheme, including the levels grid and indicative content

Examiner's comment

The nature of these questions means that students cannot rely on reciting knowledge. Questions will ask them to bring together aspects of their sociological knowledge in ways they will not have done before. It is therefore important for students to allow time to think about how to answer the question. Students should be made aware that there are two types of 10 mark questions. These have different requirements and different mark schemes . There are different marks available for the assessment objectives. A breakdown of the marks awarded by assessment objective can be found in the mark scheme. 10 mark “outline and explain” questions have more marks available for knowledge and understanding, and none for evaluation. Introductions and conclusions are not required for 10 mark questions; they take up time and rarely improve the mark. It is helpful if answers are set out to clearly indicate the two answers, with wording such as “One way/reason is…”, or by starting a new paragraph for the second point. Answers that give more than two points are unlikely to develop two of them sufficiently. Q7: Students generally chose to interpret this question as referring to issues of access to health care. Responses often used issues of language and gender inhibiting take up and use of health care amongst certain ethnic groups. Other answers referred to possible ethnocentrism and racist attitudes amongst health care professionals as restricting the take up and use of health care services among some ethnic groups.

Notes from the mark scheme and report

• two ways each developed (e.g. location of services, language barriers, cultural and religious unfamiliarity of staff, preference for staff of similar background, stigma around mental health, distrust)
• drift into health care provision in general = 1–3
• most treated this as access, using language, gender norms and ethnocentrism or racism among professionals

Mark scheme, including the levels grid and indicative content

Examiner's comment

The ‘outline and explain’ 10-mark question. Here students would benefit more if an explicit identification of a way / reason / factor was made then leading to an explanation of it. So, making the student’s answer more cogent. This question was not answered well, and many students did not seem clear on what the question wanted them to do. Some students talked about health chances rather than health care – which limited the amount of credit they could be given. Popular approaches to the question focussed on language barriers and racism / ethnocentrism amongst some health care professionals.

Notes from the mark scheme and report

• must be professionals' attitudes affecting access to health care, not health chances
• drift into general ethnicity and health = 1–3
• common answers: language barriers, racism/ethnocentrism
• top band analysis of differences between minority groups
• not answered well

Mark scheme, including the levels grid and indicative content

Examiner's comment

The nature of these questions means that students cannot rely on reciting knowledge. Questions will ask them to bring together aspects of their sociological knowledge in ways they are unlikely to have done before. It is therefore important for students to allow time to think about how to answer the question. Students should be made aware that there are two types of 10 mark questions. These have different requirements and different mark schemes. There are different marks available for the assessment objectives. The items for 10 mark “analyse” questions are written to give prompts or “hooks” for student answers. These have to be used to access application marks. Answers can indicate use of hooks by quoting, by a reference in parentheses or by wording (eg “As the item says…”). Items end with a sentence restating the question; the hooks are in the preceding part of the item. Introductions and conclusions are not required for 10 mark questions and take up valuable time. It is helpful if answers are set out to clearly indicate the two separate points, with wording such as “One way/reason is…” or by starting a new paragraph for the second point. Answers that give more than two points are unlikely to develop two of them sufficiently. Question 8: Region is included in the specification for this topic, and was explained in the item. The item helped students make points about the ways in which health care provision may vary between urban and rural areas, and between areas with different levels of prosperity.

Notes from the mark scheme and report

• hooks: prosperous vs deprived regions, urban vs rural
• e.g. private health care in prosperous areas, hospital access in towns, waiting lists
• drift into health care provision in general = 1–3
• region is in the spec and explained in the item

Mark scheme

Examiner's comment

This question was generally answered well. Popular routes were: discrimination within health, physical access to the place of health care and accessibility of the building once there. Partial marks generally arose from students identifying a difficulty but offering no explanation of it.

Notes from the mark scheme and report

• 1 mark for the difficulty, +1 for explaining it (e.g. professionals' prejudice, mobility problems getting to appointments, information in unsuitable formats)
• naming a difficulty without explanation = 1

Mark scheme, including the levels grid and indicative content

Examiner's comment

The ‘outline and explain two’ 10 mark question (the fourth question in every topic area). Here students would benefit more if an explicit identification of a way / reason / factor was made, then leading to an explanation of it, making the student’s answer more cogent. Most students were able to engage with this question. The question required students to link a number of elements together. Students could often give good reasons as to why women might seek out health care more than men and why men may do the opposite. This was the most successful part of student answers. Moving on to making a link between the higher/lower morbidity patterns that gender related access created was a less successful feature of student answers.

Notes from the mark scheme and report

• two ways gendered access to professionals shapes gender patterns of health (e.g. men less likely to attend surgeries or take time off work, women more willing to admit illness, public health campaigns, gender of professionals)
• general accounts of gender differences in health = 1–3
• many explained why women seek care more but did not link this back to morbidity patterns

Mark scheme

Examiner's comment

For low mark tariff questions where candidates are required to either define, explain or outline, care should be taken to ensure that points are not just identified. Students who had prepared to answer questions on this topic almost always scored 2 marks. Students who answered questions on multiple topics hardly ever scored any marks.

Notes from the mark scheme and report

• 2 marks for those in greatest need receiving the fewest resources
• 1 mark for a partial answer (poor people get a poor service)
• prepared students usually scored 2
• students answering every topic rarely scored

Mark scheme

Examiner's comment

For low mark tariff questions where candidates are required to either define, explain or outline, care should be taken to ensure that points are not just identified. This question was generally answered well. Partial responses included poverty but this was not always developed into an answer directly related to accessing health care. There were a variety of responses that failed to gain credit, for example countries with no health care or children not having the language skills to tell parents they are ill.

Notes from the mark scheme and report

• 1 mark for the example +1 for explaining the barrier to access (parents' lack of transport, lack of confidence with professionals, cannot afford private care)
• poverty often not developed into access
• countries without health care or children's language skills not credited
• this part's examiners' comment is also attached to 13 in the source

Mark scheme, including the levels grid and indicative content

Notes from the mark scheme and report

• no marks for evaluation in this question type
• two ways each developed, e.g. private health care widening inequality, preferential treatment of articulate middle-class patients, inverse care law, ideological role of diagnosis
• general accounts of health professionals = 1–3
• no examiners' report comment for this part

Mark scheme, including the levels grid and indicative content

Notes from the mark scheme and report

• reasons for CLASS differences in consumer choice of health care
• e.g. access to information, trust in professionals, ability to pay for private care, cultural capital, regional availability
• drift into gender or ethnic differences = 1-3
• no marks for evaluation in this question type (examiners' report general remark)

Mark scheme, including the levels grid and indicative content

Notes from the mark scheme and report

• apply Item E (low income, disadvantaged areas, preference for family/community support)
• e.g. fewer accessible services in deprived areas, delaying seeking care, poor diet linked to low income
• evaluation e.g. differences between minority ethnic groups
• class differences in health = tangent

Mark scheme, including the levels grid and indicative content

Examiner's comment

As last year, many scripts had one substantial answer to the Section A 20-mark question and one significantly briefer one for Section B, suggesting problems with timing. There was often little evidence of planning. A wide range of material can be relevant to these questions, and students are not expected to include everything. They need to carefully choose the content and to plan their answers. The best answers will be both empirical and theoretical, for example showing knowledge of research findings and examples, and knowledge of theoretical perspectives. Some answers amounted to lists of theoretical perspectives, with learned points of criticism, and lost focus on the question itself. While the items are intended as a helpful starting point for answers, they should not be taken by students as a full list of what is relevant; better answers will draw in other relevant knowledge and ideas. Most students were able to use a range of sociological knowledge and understanding to answer this question and to address both “health chances” and “heath care” in their responses.

Notes from the mark scheme and report

• must address both health chances and health care
• top band compares perspectives
• item hook: women's lower death rates despite patriarchal medicine
• AO split from AQA's standard grid for this paper (this year's mark scheme does not print it).

Mark scheme, including the levels grid and indicative content

Examiner's comment

The requirements of the 10-mark question seem to be well understood by the majority of students. Many students saw this question in relation to health chances rather than access to health care. These answers therefore often struggled to explain how their chosen factor affected class differences in access to health care. Furthermore, some answers failed to stick to material factors but instead spent time outlining cultural differences between social classes and their attitudes to health. More successful responses made reference to the costs of treatment, especially private health care. Others discussed issues to do with lack of transport, getting time off work and the nature of hourly paid employment for many working-class employees. The inverse care law featured in a number of answers, but many students struggled to apply it specifically to the question of access to health care.

Notes from the mark scheme and report

• AO grid not printed
• no marks for evaluation in this question type
• must be material factors and access to health care, e.g. cost of private treatment, time off work, transport, inverse care law
• many wrote about health chances rather than access, or about cultural attitudes
• drift into health chances = 1–3
• AO split from AQA's standard grid for this paper (this year's mark scheme does not print it).

Mark scheme, including the levels grid and indicative content

Examiner's comment

Some students wrote introductory paragraphs and/or conclusions. These are not necessary, and are unlikely to gain additional marks, and they also take up time. Some students made only one point in their answers, or three or more, rather than the two asked for in the question. Sometimes it was unclear how many points were being made. It is helpful for students to clearly indicate their two answers, with wording such as “One way is…” or by starting a new paragraph for their second point. Evaluation is not a requirement for answers to 10 mark “outline and explain” questions. The marks awarded for the assessment objectives being targeted are different in the two types of ten mark questions, and students should be made aware of this. The best answers to 10 mark questions were focused, clearly stating a point and then developing it, using sociological concepts, evidence and theory where appropriate. In some questions students tended to focus on the first aspect of the question at the expense of the second. Students need guidance on how to approach these questions and how to best demonstrate their sociological understanding. The nature of these questions means that students cannot rely on reciting knowledge. These questions will ask them to bring together aspects of their sociological knowledge in a way that they are unlikely to have done before. Most students were able to explain two ways in which health professionals affect inequalities in health care. Inequalities addressed included those based on age, social class, ethnicity and region, with popular answers including the distribution of resources and the ways in which different quality services might be provided to different groups.

Notes from the mark scheme and report

• two ways professionals widen or reduce inequalities in health care (e.g. better service for middle-class patients, ethnocentrism, rationing for the elderly, private practice, location of services)
• drift into inequalities in health chances = 1–3
• good answers covered age, class, ethnicity and region
• AO split from AQA's standard grid for this paper (this year's mark scheme does not print it).

Mark scheme, including the levels grid and indicative content

Examiner's comment

The 10 mark outline and explain question requires students to link two aspects of the specification. The best answers took note of both aspects of the question, clearly identified two separate points and developed them in relation to the second part of the question. Weaker answers either ignored one aspect of the question or attempted to cover a number of ideas rather than focusing on two. Limited access to health care due to material factors, cultural beliefs, language barriers and racism of health professionals were the most common ways offered by successful students. Differential beliefs about what constitutes a medical condition and different attitudes to traditional remedies were also popular responses. Successful answers were able to explain how these ways affected differences in accessing health care and explained explicitly how these led to ethnic differences in health chances. Less successful students tended to make unsupported statements about, for example, the educational levels of different ethnic groups, or tended just to assert the reason without any appropriate discussion or analysis.

Notes from the mark scheme and report

• two ways access to care explains ethnic health differences
• examples: material barriers, language, beliefs about illness, gender norms about doctors, ethnocentrism of staff
• drift into ethnic health experiences in general = 1-3
• must link access to health chances
• unsupported claims about education levels of groups gained little
• AO split from AQA's standard grid for this paper (this year's mark scheme does not print it).

Mark scheme, including the levels grid and indicative content

Examiner's comment

A number of students wrote introductory paragraphs and/or conclusions. These are not necessary, and are unlikely to gain additional marks. A number of students made only one point in their answer, or three or more, rather than the two asked for. In these cases, the two best answers were rewarded and will be in future series. It is helpful for students to clearly indicate their two answers, with wording such as “One way is…” or by starting a new paragraph for their second point. The assessment objective allocations are different in the two types of 10 mark questions, and students should be made aware of this. There was a wide range of responses to these questions. A minority of students wrote very brief answers. For these 10 mark items, a simple statement of two ways, reasons or factors, without development, is not sufficient to access more than the lower marks in the mark range. The best answers were focused, clearly stating a point and then developing it, with use of sociological concepts, evidence and theory where appropriate, in ways that demonstrated the skills expected from the targeted assessment objectives. There was a tendency, however, for many answers to focus on the first aspect of the question at the expense of the second. Students need guidance on how to approach these questions and how to best demonstrate their sociological understanding. The nature of these questions means that students cannot rely on reciting knowledge. They require students to bring together two aspects of their sociological knowledge in a way that they are unlikely to have done before. Answers will sometimes require claims that students may be unsure of because they do not know of specific evidence (for example, in question 5, whether migrants from Eastern Europe who are single workers tend to live alone or in shared households). However, answers that are sociologically plausible will be accepted. Students found it difficult to make connections between their knowledge of the globalised health industry on the one hand and health care in the UK on the other, and some wrote about one with little, if any, reference to the other. Better answers often identified one positive effect, such as availability of medicines or procedures, and one negative effect, such as the pursuit of profit by transnational pharmaceuticals leading to less money being available for health care.

Notes from the mark scheme and report

• must connect the global health industry to UK health care
• e.g. pharmaceutical pressure on prescribing, medicalisation
• drift into UK health care in general = 1–3
• many wrote about one side with little reference to the other
• better answers gave one positive (availability of drugs/procedures) and one negative (profit draining NHS funds) effect

Mark scheme, including the levels grid and indicative content

Examiner's comment

The 10 mark outline and explain question requires students to link two aspects of the specification. The best answers took note of both aspects of the question, clearly identified two separate points and developed them in relation to the second part of the question. Weaker answers either ignored one aspect of the question or attempted to cover a number of ideas rather than focusing on two. Cultural factors around older people’s expectations of health and attitudes to consulting the doctor were the most common reasons offered by successful students. Differential work opportunities and differences in immune systems were also popular responses. Successful answers were able to explain how these factors affected different age groups and explained explicitly how they led to differences between age groups regarding consultation rates. Less successful students tended to drift away from age into considerations of gender or ethnicity, or tended just to assert the reason without any appropriate discussion or analysis.

Notes from the mark scheme and report

• no marks for evaluation in this question type
• two reasons each developed and explicitly linked to consultation rates, e.g. older people not at work, children's vulnerable immune systems, routine screening
• common answer: cultural attitudes of older people
• drift into gender or ethnicity limits marks

Mark scheme, including the levels grid and indicative content

Notes from the mark scheme and report

• item hooks: longer GP consultations, referrals, preventative care
• top band e.g. middle-class health knowledge and confidence with doctors
• analysis of cultural vs economic factors
• ethnic or gender differences in access are a tangent