EQUITY IN HEALTHCARE

Joko Mulyanto BHL 3 - 2009

Definition
Justice according to natural law or right; specifically: freedom from bias or favoritism.
The state, ideal, or quality of being just,

impartial, and fair. Equity Equality Equality is sameness, Equity is fairness The concept of equity based on social justice theories , which depend on the ideology of society .

Ideological Perspective of Equity

Equity vs. Altruism
Altruism is about preferences; Equity is about

a persons right. Libertarian vies vs. Egalitarian view Libertarian view of equity: distribution according to financial ability Marxist /socialist/ egalitarian view of equity: distribution according to need

Operational Definition
Horizontal equity : the allocation of equal or equivalent resources for equal need

- Equal access for equal need - Equal treatment for equal need Vertical equity : the allocation of different resources for different levels of need - Unequal treatment for unequal need - Progressive financing system

Access and Need

What is access ?

the maximum attainable level of consumption of medical care, given the individuals income, and the time and money prices associated with consuming medical care. What is need ? the amount of resources required to exhaust capacity to benefit

Equity of What ?
Equity in access of healthcare; delivery and financing of healthcare.
Equity in health outcome; is it possible ?

Equity principles in the delivery of healthcare

Healthcare should be distributed according to peoples need not their ability to pay.
Why healthcare?

Healthcare is the instrument to achieve health.

Health is consider as the condition for

peoples functioning and well being. Health is basic need and right for people.

Equity principles in ability to pay

Healthcare should be financed according to their ability to pay.
Decoupling payment from utilization

Progressive payment

Equity in Health Outcome

Equity in access of healthcare not automatically

resulted in fair distribution of health outcome; Inequity of health The term inequity has a moral and ethical dimension. It refers to differences which are unnecessary and avoidable but, in addition, are also considered unfair and unjust. So, in order to describe a certain situation as inequitable, the cause has to be examined and judged to be unfair in the context of what is going on in therest of society.

 Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically,

that no one should be disadvantaged from achieving this potential, if it can be avoided.

Determinants of Health Disparities

Natural, biological variation.

Health-damaging behaviour if freely chosen, such as participation in certain sports and pastimes.

The transient health advantage of one group over another when that

group is first to adopt ahealth-promoting behaviour (as long as other groups have the means to catch up fairly soon).
Health-damaging behaviour where the degree of choice of lifestyles

is severely restricted.
Exposure to unhealthy, stressful living and working conditions. Inadequate access to essential health and other public services. Natural selection or health-related social mobility involving the

tendency for sick people to move down the social scale.

Criteria of Health Inequity

The disparities is avoidable.
The disparities is not reflect free choice. There is link between disparities and

responsible agent.

Avoidability
Technically avoidable

Current science and knowledge provides proven successful intervention. Financially avoidable There are sufficient resources exist to satisfy fair condition. Morally avoidable the proposed redistributionwould not violate some other, greater, sense of justice.

Choice
Sufficient resources to establish free choice
Legal right to utilize the resources

Agency
Responsible agent;
Culpable entity Accountable entity

Spectrum of Disparities

Concluding Remarks
Equity refers to differences that are unnecessary or reducible and are unfair and unjust. The concept of fairness obviously involves a moral judgement and is, therefore, intrinsically difficult. As is the case with health outcomes, similarly the inequities in health determinants are those that should not exist. Every person should, in terms of equity, have the opportunity to access those sanitary and social measures necessary to protect, promote and maintain or recover health (Sir George Alleyne)