Equity and efficiency

Abstract

There are insufficient resources to meet all health care needs, and some form of prioritization is needed to ensure that these limited resources are used to their best effects. Resource allocation decisions need to account for the goals of a health care system, which can be numerous, diverse, and possibly in conflict with each other. Two such goals, central in many health care systems worldwide, are to provide health care both efficiently and equitably. Efficiency is usually considered in terms of the relationship between resource inputs and outputs, with the aim being to maximize "value" from the given resources. While the acceptability of including efficiency considerations in resource allocation decisions, the methods of doing so, and subsequent successes vary, seeking efficiency is a relatively noncontroversial aim for any health care system. Equity refers to the fair allocation of resources and involves subjective and moral judgement. It differs from equality, which refers to an objectively equal distribution of inputs or outcomes across a population. Definitions of equity are characterized by variations in underlying principles of access and need. While many governments consider equity alongside efficiency in policymaking, methods for doing so are not as explicit as those for efficiency considerations, and there is a belief that the two criteria of efficiency and equity are not fully compatible.