Abstract
Three common “Es” have high ethical and political content for health policy: efficiency, equity, and equality. This entry examines the links between the three, with especial attention given to (a) the claimed conflict between efficiency and equity, (b) the equity of inequalities, and (c) the conflict between six equity principles: equal health, equal health gain, equal value of additional health, maintaining existing distributions, allocation according to need, and equal per capita resources. Conclusions include: efficiency and equity do not inherently conflict, an inefficient allocation can be equitable, an efficient allocation can be inequitable, an inefficient allocation can become more efficient without increasing inequity, what is equitable often requires inequality in health and inequality in resource distribution per capita, equality in health requires inequality in resource allocation, equality in resource allocation typically leads to inequality in health, and allocation according to need typically leads to inequality in health.
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References
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Further Readings
Aristotle (1972) Nicomachean Ethics. Book V. (trans: Ross, D.). Oxford: Oxford University Press.
Chalkidou, K., Tunis, S., Lopert, R., Rochaix, L., Sawicki, P. T., Nasser, N., & Xerri, B. (2009). Comparative effectiveness research and evidence-based health policy: Experience from four countries. Milbank Quarterly, 87, 339–367.
Culyer, A. J. (1998). Need – Is a consensus possible? Journal of Medical Ethics, 1998(24), 77–80.
Culyer, A. J. (2006). The bogus conflict between efficiency and equity. Health Economics, 15, 1155–1158.
Culyer, A. J. (2007). Need – An instrumental view. In A. Richard, D. Angus, D. Heather, & M. M. John (Eds.), Principles of health care ethics (2nd ed., pp. 231–238). Chichester: Wiley.
Culyer, A. J., & Lomas, J. (2006). Deliberative processes and evidence-informed decision-making in health care – Do they work and how might we know? Evidence and Policy, 2, 357–371.
Lomas, J., Culyer, A. J., McCutcheon, C., McAuley, L., & Law, S. (2005). Conceptualizing and combining evidence for health system guidance. Ottawa: Canadian Health Services Research Foundation.
Acknowledgments
This entry is based on Culyer and Wagstaff (1993). The author is grateful for the incisive comments of Ruth Faden and Carleigh Krubiner.
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Culyer, A.J. (2015). Equality and Equity. In: ten Have, H. (eds) Encyclopedia of Global Bioethics. Springer, Cham. https://doi.org/10.1007/978-3-319-05544-2_176-1
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DOI: https://doi.org/10.1007/978-3-319-05544-2_176-1
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