Hostname: page-component-76fb5796d-9pm4c Total loading time: 0 Render date: 2024-04-26T05:46:24.924Z Has data issue: false hasContentIssue false
  • English
  • Français

What does Equity in Health Mean?*

Published online by Cambridge University Press:  20 January 2009

João Pereira
Get access Rights & Permissions [Opens in a new window]

Abstract

Up until very recently, the international debate on health inequality tended to disregard the issue of specifying equity objectives precisely. This was unfortunate, given the importance of normative analysis for understanding why people care about social justice in the field of health; the extent to which specific types of inequality are compatible with equity; how the concept should be measured; and how rational policies may be formulated and monitored. This article critically appraises six well established approaches to defining equity—egality, entitlement, the decent minimum, utilitarianism, Rawlsian maximin, and envy-free allocations—as well as two alternative formulations recently proposed by health economists—equity as choice and health maximisation. All of these are found wanting in some respect when applied to the health sector. It is argued that Sen's ‘capabilities’ concepts, strangely ignored by health services researchers in the past, could prove an effective framework within which to organise research and policy formulation in the area of health and health care inequality.

Type
Articles
Information
Journal of Social Policy , Volume 22 , Issue 1 , January 1993 , pp. 19 - 48
Copyright
Copyright © Cambridge University Press 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Archibald, G.C. and Donaldson, D. (1979). ‘Notes on economic equality’, Journal of Public Economics, 12, 205–214.CrossRefGoogle Scholar
Atkinson, A.B. (1970), ‘On the measurement of inequality’, Journal of Economic Theory, 2, 244–63.CrossRefGoogle Scholar
Ayach, P., Carr-Hill, R., Curtis, S. and Illsley, R. (1987), Les Ineqalite‘s Sociales en Santf en France et Grande-Bretagne, DF-Inserm, Paris.Google Scholar
Baumol, W.J. (1986), Superfairness: Applications and Theory, The MIT Press, Cambridge, Mass.Google Scholar
Becker, G. (1965), ‘A theory of the allocation of time’, Economic Journal 75, 493–677.CrossRefGoogle Scholar
Bell, J.M. and Mendus, S. (eds) (1988), Philosophy and Medical Welfare, Cambridge University Press, Cambridge.Google Scholar
Broome, J. (1988), ‘Good, fairness and QALY's’, in Bell, J.M. and Mendus, S. (eds). Philosophy and Medical Welfare, Cambridge University Press, Cambridge.Google Scholar
Carr-Hill, R. (1988), ‘QuAIitY control: a sensitivity analysis of QALY's’, paper presented to the meeting of the Health Economics Study Group, University of Brunel, July 1988.Google Scholar
Culyer, A.J. (1971). ‘Medical care and the economics of giving’, Economica, 38, 295–303.CrossRefGoogle Scholar
Culyer, A.J. (1976), Need and the National Health Service, Martin Robertson, London.Google Scholar
Culyer, A.J. (1980), The Political Economy of Social Policy, Martin Robertson, Oxford.Google Scholar
Culyer, A.J. (1988), ‘Inequality in health services is, in general, desirable’, in Green, D.J. (ed.), Acceptable Inequalities?, The IEA Health Unit, London.Google Scholar
Culyer, A.J. (1989). ‘The normative economics of health care finance and provision’, Oxford Review of Economic Policy, 5, 34–58.CrossRefGoogle Scholar
Culyer, A.J. (1990), ‘Commodities, characteristics of commodities, characteristics of people, utilities and the quality of life’, in Baldwin, S., Godfrey, C. and Propper, C. (eds). The Quality of Life: Perspectives and Policies, Routledge and Kegan Paul, London.Google Scholar
Daniels, N. (1981). ‘Health care needs and distributive justice’, Philosophy and Public Affairs, 10, 146–79.Google ScholarPubMed
Dardanoni, V. and Wagstaff, A. (1987). ‘Uncertainty, inequalities in health and the demand for health’, Journal of Health Economics, 6, 283–90.CrossRefGoogle ScholarPubMed
DHSS (1980), Inequalities in Health, Report of a Research Working Group chaired by Sir Douglas Black, DHSS, London.Google Scholar
Dworkin, R. (1981). ‘What is equality’, Philosophy and Public Affairs, 10, 185–246 and 283–345.Google Scholar
Enthoven, A. (1980), Health Plan: The Only Practical Solution to the Soaring Cost of Medical Care, Addison-Wellesley, Reading, Mass.Google Scholar
Feldman, A.M. (1987). ‘Equity’, in Eatwell, J., Milgate, M. and Newman, P. (eds). The New Palgrave: A Dictionary of Economics, Macmillan, London.Google Scholar
Fox, J. (ed.) (1989), Health Inequalities in European Countries, Gower, Aldershot.Google Scholar
Green, D.J. (1988). Acceptable Inequalities? The IEA Health Unit, London.Google Scholar
Grossman, M. (1972), The Demand for Health: A Theoretical and Empirical Investigation, National Bureau of Economic Research, New York.Google Scholar
Harris, J. (1987). ‘QALYfying the value of life’, Journal of Medical Ethics, 13, 217–25.CrossRefGoogle ScholarPubMed
Harris, J. (1988). ‘More and better justice’, in Bell, J.M. and Mendus, S. (eds), Philosophy and Medical Welfare, Cambridge University Press, Cambridge.Google Scholar
Hochman, H.H. and Rogers, J.D. (1969) ‘Pareto-optimal redistribution’. American Economic Review, 59. 542–57.Google Scholar
Illsley, R. and Svensson, P.G. (eds) (1986), The Health Burden of Social Inequities, WHO Regional Office for Europe, Copenhagen.Google Scholar
Lancaster, K.J. (1966), “A new approach to consumer theory’, Journal of Political Economy, 74, 132–57.CrossRefGoogle Scholar
Le Grand, J. (1982), The Strategy of Equality: Redistribution and the Social Services, George Allen and Unwin, London.Google Scholar
Le Grand, J. (1984). ‘Equity as an economic objective’, Journal of Applied Philosophy, 1, 39–51.CrossRefGoogle Scholar
Le Grand, J. (1986), ‘Inequalities in health and health care: a research agenda’, in Wilkinson, G. (ed.), Class and Health: Research and Longitudinal Data, Tavistock, London.Google Scholar
Le Grand, J. (1987). ‘Equity, health and health care’, Social Justice Research, 1, 257–74.CrossRefGoogle Scholar
Le Grand, J. (1991), Equity and Choice, Harper Collins, London (in press).CrossRefGoogle Scholar
Lindsay, C.M. (1969). ‘Medical care and the economics of sharing’, Economica, 36, 351–62.CrossRefGoogle Scholar
Loewy, E.H. (1987), ‘‘Communities, obligations and health care’’. Social Science and Medicine, 25, 783–91.CrossRefGoogle ScholarPubMed
Loomes, G. (1988), ‘Disparities between health state measures: an explanation and some implications’, paper presented to the Meeting of the Health Economists Study Group, University of Brunel, July.Google Scholar
Mooney, G.H. (1983). ‘Equity in health care: confronting the confusion’, Effective Health Care, 1, 179–85.Google ScholarPubMed
Mooney, G.H. (1986), Economics, Medicine and Health Care, Wheatsheaf Books, Brighton.Google Scholar
Mooney, G.H. (1987), ‘What does equity in health mean?, World Health Statistics Quarterly, 4.Google Scholar
Muellbauer, J. (1987), ‘Professor Sen on the standard of living’, in Sen, A., The Standard of Living, Cambridge University Press, Cambridge.Google Scholar
Nozick, R. (1974), Anarchy, State and Utopia, Basic Books, New York.Google Scholar
O'Higgins, M. (1987), ‘‘Egalitarians, equalities and welfare evaluation’’. Journal of Social Policy, 16, 1–18.CrossRefGoogle Scholar
Pazner, E.A. and Schmedlier, D. (1978). ‘Egalitarian equivalent allocations: a new concept of economic equity’, Quarterly Journal of Economics, 92, 671–87,CrossRefGoogle Scholar
Rawls, J. (1971), A Theory of Justice, Harvard University Press, Cambridge. Mass.CrossRefGoogle Scholar
Sen, A. (1973), On Economic Inequality, Clarendon Press, Oxford.CrossRefGoogle Scholar
Sen, A. (1980), ‘Equality of what?’, in Choice, Welfare and Measurement, Basil Blackwell. Oxford, 1982, 353–69.Google Scholar
Sen, A. (1983), ‘Poor, relatively speaking’, Oxford Economic Papers, 35. 153–69.CrossRefGoogle Scholar
Sen, A. (1985), Commodities and Capabilities, North Holland, Amsterdam.Google Scholar
Sen, A. (1987a), ‘Justice‘, in Eatwell, J., Milgate, M. and Newman, P. (eds), The New Palgrave: A Dictionary of Economics, Macmillan, London.Google Scholar
Sen, A. (1987b), The Standard of Living, Cambridge University Press, Cambridge.CrossRefGoogle Scholar
Sloan, F. and Bentkover, J.D. (1979), Access to Ambulatory Care and the U.S. Economy, Lexington Books, Lexington, Mass.CrossRefGoogle Scholar
Smith, A. (1987), ‘Qualms about QALY's’, The Lancet, 1, 1134.CrossRefGoogle Scholar
Van Doorslaer, E., Wagstaff, A. and Rutten, F. (eds) (1992), Equity in the Finance and Delivery of Health Care: An International Perspective, Oxford University Press, Oxford.CrossRefGoogle Scholar
Varian, H.F. (1974). ‘Equity, envy and efficiency’, Journal of Economic Theory, 9, 63–91.CrossRefGoogle Scholar
Wagstaff, A. (1991), ‘QALY's and the equity-efficiency trade-off, Journal of Health Economics, 10, 21–11.CrossRefGoogle ScholarPubMed
Williams, A. (1988), ‘Ethics and efficiency in the provision of health care’, in Bell, J.M. and Mendus, S. (eds), Philosophy and Medical Welfare, Cambridge University Press, Cambridge.Google Scholar