Health, health expenditures and equity

This paper offers some reasons why it may be interesting to examine the distribution of health, health care, and payments for health care. The reason for a legitimate concern for these distributions is mainly because they relate to a more fundamental concern with the distribution of health itself. It is argued that an equitable distribution must take account of the whole distribution and that it is insufficient to discuss equity in terms of minimum standards. A concept of need based on capacity to benefit from health care is clarified and applied. Horizontal equity is considered in terms of three alternative principles, whose consistency with one another and with efficiency are examined using a diagrammatic technique that enables the simultaneous consideration of carious equity principles and efficiency. It is shown that equality of treatment in the senses of outcome or input are mutually consistent under particular conditions, and also consistent with efficiency.