Equity in Healthcare

Summary:

Equity in Healthcare: an Introduction

Equity Example

The dilemma for policy makers

Concept of Healthcare Equity

Equity in Healthcare: an Introduction:

In the healthcare context, 'Equity' refers to the principle of fairness and justice in the distribution of healthcare resources and opportunities. It ensures that all individuals, regardless of their socio-economic status, ethnicity , gender or other factors, have equal access to healthcare services and receive the same quality of care. In countries where there is government funding of healthcare or government regulated funding, allocating resources considering the differences is the need. The most common approach of allocation is by 'the common allocation approach'- based on population, age, gender and morbidity. The allocation should be proportionate to the measures of need. This approach has been done to weigh the funding towards those with worse health. This demonstrates how challenging it can be to implement the objectives to generate vertical equity.

( Vertical Equity- The unequal support for unequal's and Horizontal Equity- the equal treatment of equals.)

Equity Example:

Rural                                    Public health and health services                                                           Urban

population                    (focuses to reduce the difference in rural and urban)                             population

Based on an experience in an urban area in England;

Assumption: Cost of lowering the rate of diseases and bridging the difference is high and service users are mostly costly to reach and the healthcare system is expected to do less to lower the number of mortalities for low income groups.

England is taken here because Government is funding the healthcare in the country and it is a welfare state. Poorest part of the district have the highest rates of treatable coronary heart disease, but are getting less treatment than the more prosperous parts. Least capacity to benefit were getting more and those likely to benefit more got less.

In this case, allocation of resources is inefficient( more improvement could be achieved with the existing budget) and greater efficiency will lead to greater equity.

Necessity: Being ill or at risk is a necessary condition to be able to benefit from treatment. 

Often, those who can benefit most are those with low incomes and above average morbidity. In some cases, it becomes more expensive to treat poorer people and they may need longer time in hospital. So, the cost of running the this treatment becomes higher. 

Those choosing to attend the screening program tend to be those who are richer and have less disease and screening is organized for the people in the richer class, so, the cost of organizing becomes less and the outcome is maximum. In this case, the concept of equity is violated. The screening should have been organized for all class of people, regardless of the cost factor and the outcome of the program.

Observation: The problem of health equity is largely a problem of a more general economic and social inequality, and the solution lie outside the health sector. It is relative ( rather than absolute) poverty that is associated with poor health.

Learnings: Countries with great social inequality have worse health on average than that are more equal. The rapid changes in central and eastern Europe from the 1990's were associated with a rapid increase in income inequality and worsening of health. Countries with state funding or social insurance funding aim to provide nearly equal access to important services.

Conclusion: Normally state should offer care on the basis of need and not income or ability to pay. The design may be equal access, but the reality is that those with more money get better access.

The dilemma for policy makers:

Prevent more deaths by spending on urban areas, but at the same time the disparity between different income class becomes wider. Everyone likes to see both fewer deaths and less inequality.

But there are many questions making this difficult choice between a more efficient intervention (i.e. fewer deaths) and a more equitable one.

Concept of Healthcare Equity:

The following steps helps clarify the concept of Healthcare equity.

Firstly, there is a distinction between equality and equity.

Something is unequal means that it is considered inequitable or unfair. Example: people born with diseases or disabilities will tend to use more health services than people without illness, giving rise to unequal utilization which is necessary, not inequitable. Amongst people who are born with diseases and disability, richer people use more health services than poorer people- inequality as inequitable.

Secondly, what is the 'thing' that health policy makers seek to distribute equitability?

Providing equal access to healthcare will not give rise to equal utilization of healthcare or an equal distribution of health ( unless everyone has the same initial health status and the same capacity to benefit from healthcare). Similarly, ensuring equal utilization of healthcare will not necessarily yield an equal distribution of health (Smith and Normand, 2011).

Thirdly, should the focus be on vertical or horizontal equity?

Horizontal equity is the equality in the treatment of people with equal needs. Vertical equity is the unequal treatment of unequal's where people have unequal needs for healthcare. The treatment will be appropriately unequal. Whether the focus is on horizontal or vertical equity, analysts require some means of measuring and controlling for healthcare needs. Need could be defined in terms of scale of suffering and health problems, or in terms of capacity to benefit.