Purpose: This paper establishes an association between income and the likelihood of seeking medical treatment for Covid-19 symptoms in some countries . We provide an explanation for this income effect based on the stringency of government response to the pandemic and the unequal distribution of agency among social classes . Design/methodology/approach: The paper makes use of data from the Six-Country Survey on Covid-19 to establish the existence of an income effect on health utilisation, and from the Oxford Covid-19 Government response tracker to show that this income effect is associated with the stringency of governmental response to the pandemic . Data from the 2011/12 “ Health and Healthcare ” round of the International Social Survey Programme is used to show that this income effect cannot be explained by pre-existing patterns . An explanation for the link between government stringency and the income effect is advanced on a theoretical basis . Findings: The authors find in Britain, the US, and – with greater uncertainty – in Japan that individuals who experience potential Covid-19 symptoms are less likely to seek medical treatment if they have a lower income . The authors also show that governments in these countries adopted a less stringent response to the pandemic than the countries in our sample which do not exhibit an income effect – China, Italy and South Korea . The authors argue that laissez-faire policies place the burden of action upon the individual, activating underlying differences in agency between the social classes, and making (high) low-income individuals (more) less likely to seek medical attention . Research limitations/implications: Since there was not a direct measure of agency in the data, it could not be empirically verified that agency mediates the effect of government stringency on health utilisation . Further research could make use of datasets which incorporate such a measure, if they become available . It could also extend the geographical scope of the findings, to see if the income effect manifests in other countries which adopted a laissez-faire response to the pandemic . Practical implications: Governments should intervene more stringently during pandemics to minimise inequality in health outcomes . Originality/value: This paper establishes an association between the stringency of government response to the Covid-19 pandemic and income inequality in health utilisation . This contributes to scholarly and policy debates around health inequality in the area of social epidemiology, and the sociology of inequality more generally . It is also of relevance to the general public, in the context of a deadly pandemic.