Are Inequalities In Health Care Consistent With Equity In Access?

Most developed countries aim for health services which are basically egalitarian. Thus equity and equality are important factors in the monitoring, evaluating and/or planning of health services. However, the achievement of equity in health and health-care is problematic. Inequalities in health status arise from a wide range of social, environmental, economic and genetic factors. Inequity in access to health care can result from inherited inequalities in financial and physical provision of health care, geographical problems of access, and different medical values and priorities. For many reasons, which are well documented, achieving total equality in health status is probably impossible. However, even the achievement of equity in access to health care raises a number of problems. Further, recent interest in reforming health-care systems and the debates on priority-setting and rationing in different countries have raised new fears of increasing inequalities in access to health care. This paper presents a critical analysis of a number of different approaches to conceptualising, measuring and operationalising equity in access to health care. In particular, it explores which inequalities in health-care provision are consistent with, and which indeed are necessary for, equity in access to health care. It also examines a particular problem of inequality in the UK: “rationing by post-code”.