Inequality Mechanisms

The article interprets the findings as a two-stage model in which deprivation first shapes ED access pathway and referral pathway then shapes outcomes. Observable inequality in ED service performance is described as mostly generated upstream before arrival at the department. Structured pathways may improve ED processing because patients arrive with documentation and clearer clinical information. Limited GP availability and barriers to securing appointments are proposed as supply-side mechanisms behind the deprivation-referral gradient. Lower health literacy and reduced trust may discourage primary care engagement in more deprived populations.