Sources of disagreement about access

The fair equality of opportunity account has important implications for the public policy debate about access to personal medical services. But to see what is useful and distinctive about the account, it will be necessary to look at the extensive and diverse empirical literature on access. My concern, however, is conceptual and moral, not empirical. I will not try to resolve disputes about numbers.

The literature on equity of access is complex and confusing. Indeed, there is not consensus on what counts as ‘equitable access’. There are three central reasons for divergence on this question. First, access is itself a complicated notion, a composite of many factors. Consequently, determining what counts as equality of access, let alone equity of access, is a non-trivial problem; moreover, in some cases considerations about equity already play a role in our judgements about equality. Second, health-care services are non-homogeneous. They have many functions, some more important, more basic, or more urgent than others. So, as I noted in Chapter 1, it is not possible to settle questions about equity of access until we have made it clear what the access is to. Are we worried about access to all the services offered in our health-care system? Or are we worried only about a key set of services, defined by reference to some central or basic function, regardless of their availability within our system? And how can we pick these out in the context of an evolving system and technology?