Who Gets Health Care?

Around the world, as in the United States, concern is growing about who gets health care. Individuals from different socioeconomic backgrounds face distressingly different prospects of living a healthy life. Disparities in various measures of health between the privileged and the deprived still remain wide, despite the long-term tendency toward a healthier society. Some investigators believe the shift in the health care system in industrial countries from the principle of universal access to a more market-oriented system may be one cause of the growing disparities; rising income inequality is another potential culprit. Policy makers worldwide speak of more efficiently delivering essential' health care---but disagree on what counts as essential and on the optimal mix of private and government components of service. After reviewing the economic and epidemiological literature on disparities in health and health care systems, the question of how to define essential' health care is considered. The paper concludes with a discussion of the policy implications of the analysis.