Equity.
aims to ensure fairness in how resources are shared, often focusing on equal access to health, healthcare, or related services across different population groups.
Difference between equality and equity
Equality means giving everyone the same resources or opportunities.
while equity means giving people what they need to reach the same outcome — it focuses on fairness by accounting for different circumstances.
Equity–efficiency trade-off.
means that policies promoting fairness in resource distribution can reduce economic efficiency, leading to fewer total resources available.
Horizontal equity.
Equal treatment of equals (e.g. equal access for equal need).
Resource allocation formula.
A formula that uses indicators of the relative need
for health services to guide resource allocation decisions in an effort to achieve equity
of funding across geographic areas.
User fees.
Formal out-of-pocket expenditures incurred by patients at the time of
health care use.
Vertical equity
Unequal (but fair) treatment of unequals (i.e. individuals who are
unequal should be treated differently according to their level of need).
What equity is really about
While equity is about fairness, this may or may not mean the equal
sharing of a good. It may for example be deemed fair that a disadvantaged group in
society receive a greater share of resources.
Horizontal and vertical equity
Horizontal equity is about ensuring that people in equivalent circumstances are treated
the same.
Vertical equity is about treating individuals (or communities) who are unequal.
There are three popular ways of defining horizontal equity in health care:
equal access to health care for equal need;
* equal use of health care for equal need;
* equal health care expenditure for equal need.
Vertical equity
In contrast to horizontal equity, vertical equity is to do with treating people
differently when the level of need among them differs – i.e. trying to lessen the gap
between the ‘haves’ and the ‘have nots’ through preferential treatment of the latter.
It has been referred to as a form of ‘positive discrimination’ to promote equity in
health services.
Do you think equality of health is a feasible goal?
There is a range of reasons why equality of health is often impossible to achieve. You
may have thought of the following . . .
a) Many factors infl uence health in addition to health care. In some instances, what health
services can do to affect the levels of health in populations or communities may be
quite limited.
b) Genetic differences between people mean that complete inequality of health is simply
impossible.
c) There is no consensus on what is meant by ‘good health’.
d) Equalizing health might be considered paternalistic since it may restrict individuals’
lifestyle choices which often have an impact on health.
e) If no more resources are to be made available to health services to achieve this goal, then
to achieve equal health some people’s health will need to improve and some deteriorate.
Can you think of any problems with measuring equality of access?
Equality of access requires that for different communities:
a) Travel distance to facilities and services is the same.
b) Transport and communications services are the same.
c) Waiting times are the same.
d) Patients are equally informed about the availability and effectiveness of treatments.
e) Charges are the same and ability to pay is the same.
Because of these diffi culties, health care planners will often resort to ‘use’ as an indicator of ‘access’ to health care.
But there are important differences between utilization
and access that we must be mindful of. Equal access for equal need is about providing individuals with the opportunity to use services.
Individuals may choose to comply
with treatment to different degrees and this will result in different patterns of utilization,
even among those with the same health needs. Some people will go to see a doctor or nurse and others will not. We know that religion, culture, gender, age and
education all have a bearing on treatment-seeking behaviour.
Equality of expenditure also has some limitations. Can you think of any?
This presents a problem in so far as spending the same amount on different individuals
might result in differences in outcomes because of, among other things, differences in
the cost of services between groups or areas.
This has not stopped the widespread use of equality of expenditure. Its popularity largely stems from the relative ease with
which inputs can be measured and monitored.
One critical issue to bear in mind at this point is that you will get a different policy outcome depending on what definition of equity you choose to apply.
Each definition
has its own strengths and weaknesses. Different definitions also have different data requirements. More complicated definitions, such as those that include some measure
of vertical equity, may require routinely collected survey data that does not exist in all
settings.
Definitions must also be easily interpreted by policy-makers and managers, as
well as being palatable to members of the general public.
examples that illustrate that equity and efficiency can be at odds with one
another.
Example 1: income can be transferred from people with high incomes to those with
low incomes through taxation to achieve a more equitable distribution of wealth.
Taxing people’s income from employment, however, reduces their incentive to work
and save and as a consequence introduces inefficiency.
- Example 2: a dollar taken from a wealthy person through income redistribution
policies does not generally end up as a dollar in the pocket of a poorer person. The
resources used in collecting these taxes could be used in alternative ways to produce
goods and services of higher value to the economy. - Example 3: arguments for the centralization of health services are often made on
efficiency grounds. For example, there may be a number of primary care clinics each
servicing a local population in a district. Closing down some of these clinics and
centralizing services could avoid duplication of services and allow for greater shared
costs. The equity argument would be that geographical access to services might be
reduced as some people would have further to travel. - Example 4: the introduction of user fees is a commonly cited example of the potential
trade-off between equity and effi ciency in health care. It is argued that imposing
such charges can address the problem of consumer moral hazard by deterring the
frivolous use of health services. On the flip-side, however, user fees are also reported
to impose heavy burdens on poorer groups and can therefore be inequitable.
