Abstract :
This article considers two key issues in health economics regarding
the question of equity. First, why have health economists not resolved better the
issue of what are equity and access? Second, the paper draws attention to the
relative lack of analyses of equity concerns outside of health care. The question
of whose values should prevail in equity is also addressed. On the first issue,
there is an obsession with quantification in economics with the result that in
analysing equity, in practice often ‘use’ has been substituted for ‘access’. The
problem of defining access has thereby been by-passed. This has taken the
pressure off trying to research access per se. Second, what is meant by equity and
access are in part culturally determined. The continued efforts of health
economists to treat equity as some universal construct are misplaced. The lack of
effort on the part of health economists to look at equity more broadly than
health care equity is concerning. Certainly, to be pursued in practice, equity in
both health and health care need a shift in resources, which will be opposed by
those who exercise power over decision making in health care and in society
more generally. Currently health economists’ analyses say all too little about
power and property rights in health care and in society. It is argued that the
relevant citizens or communities which a health service serves are best placed to
judge the access barriers they face and their relative heights. A useful definition
of equity established by a citizens’ jury in Perth, Australia is used to exemplify
this point. It is concluded that the often all too simplistic equity goals adopted
in health economics (and sometimes public health discourse) need to be
challenged. For health economists, there is a need for more of us to get involved
in the issues around inequalities, class and power and the impact of these on
health.
