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EQUITY IN HEALTHCARE

Joko MulyantoBHL 3 - 2009

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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 ofsociety .

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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

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Operational Definition

Horizontal equity : the allocation of equal orequivalent 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

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Equity of What ?

Equity in access of healthcare; delivery andfinancing of healthcare.

Equity in health outcome; is it possible ?

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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 forpeoples functioning and well being.

Health is basic need and right for people.

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Equity principles in ability to

pay Healthcare should be financed according to

their ability to pay.

Decoupling payment from utilization Progressive payment

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Equity in Health Outcome

Equity in access of healthcare not automaticallyresulted in fair distribution of health outcome;Inequity of health

The term inequity has a moral and ethicaldimension. It refers to differences which areunnecessary and avoidable but, in addition, are alsoconsidered unfair and unjust. So, in order to describe

a certain situation as inequitable, the cause has to beexamined and judged to be unfair in the context ofwhat is going on in therest of society.

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Equity in health implies that ideally everyoneshould have a fair opportunity to attain theirfull health potential and, more pragmatically,that no one should be disadvantaged fromachieving this potential, if it can be avoided.

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Determinants of Health

Disparities Natural, biological variation.

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

The transient health advantage of one group over another when thatgroup is first to adopt ahealth-promoting behaviour (as long as othergroups have the means to catch up fairly soon).

Health-damaging behaviour where the degree of choice of lifestylesis 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 thetendency for sick people to move down the social scale.

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Criteria of Health Inequity

The disparities is avoidable.

The disparities is not reflect free choice.

There is link between disparities andresponsible agent.

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Avoidability

Technically avoidable

Current science and knowledge provides

proven successful intervention. Financially avoidable

There are sufficient resources exist to satisfyfair condition.

Morally avoidable

the proposed redistributionwould not violatesome other, greater, sense of justice.

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Choice

Sufficient resources to establish free choice

Legal right to utilize the resources

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Agency

Responsible agent;

Culpable entity

Accountable entity

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Spectrum of Disparities

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Concluding Remarks

Equity refers to differences that are unnecessary or

reducible and are unfair and unjust. The concept offairness obviously involves a moral judgement and is,

therefore, intrinsically difficult. As is the case withhealth outcomes, similarly the inequities in healthdeterminants are those that should not exist. Everyperson should, in terms of equity, have the opportunityto access those sanitary and social measures necessaryto protect, promote and maintain or recover health

(Sir George Alleyne)