Elsevier

Journal of Health Economics

Volume 12, Issue 4, December 1993, Pages 431-457
Journal of Health Economics

Equity and equality in health and health care

https://doi.org/10.1016/0167-6296(93)90004-XGet rights and content

Abstract

This paper explores four definitions of equity in health care: equality of utilization, distribution according to need, equality of access, and equality of health. We argue that the definitions of ‘need’ in the literature are inadequate and propose a new definition. We also argue that, irrespective of how need and access are defined, the four definitions of equity are, in general, mutually incompatible. In contrast to previous authors, we suggest that equality of health should be the dominant principle and that equity in health care should therefore entail distributing care in such a way as to get as close as is feasible to an equal distribution of health.

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    We are grateful to Jack Dowie, Gavin Mooney and Joe Newhouse for helpful comments on an earlier version of this paper. The usual disclaimer applies. Much of the work leading up to this paper was written whilst Tony Culyer was a visiting professor at GSF-Medis in Munich and the Department of Health Administration at the University of Toronto, and Adam Wagstaff was visiting the Centre for Health Economics at the University of York and the Institute for Medical Technology Assessment (IMTA) at Erasmus University, Rotterdam. The support of all four institutions is acknowledged. The IMTA support was funded by a grant from Merck Sharpe and Dohme for research on ‘methodological issues in economic evaluation’.

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