In defence and pursuit of equity

As part of an invited policy debate, it is argued that health care policy reforms should promote equity, not just efficiency, as an objective. According to the efficiency-driven perspective, improving aggregate health status is the public policy goal of health care. However, efficiency-driven reforms are based on a libertarian, not egalitarian, approach, & the emphasis on aggregate health status can result in health inequities. In contrast, equity-driven approaches also require consideration of the policies & policy goals necessary to promote health equity. In In Defence and Pursuit of Equity: A Response Andrew Creese argues that issues of social justice & equity should inform health care policy reforms. Lessons learned from recent international health care policy initiatives include (1) government financial support is necessary to secure health care access for the poor; & (2) the promotion of health equity is a political as well as technical process. It is suggested that the health care policy-making process become more democratic. In In Defence and Pursuit of Equity and Efficiency, Olusoji Adeyi, James Christopher Lovelace, & Dena Ringold agree that equity & efficiency should both be promoted by health care policy. Examples from former socialist European nations are used to argue that health care equity is difficult to maintain in inefficient systems. In Pursuing Equity without Getting Beat, Stephen M. Tollman & William C. Hsiao argue that neither centrally planned (equity-driven) nor market-driven (efficiency-driven) health care programs separately have been able to satisfactorily promote equity & efficiency in health care delivery. To be effective, health care initiatives should incorporate elements of both the equity & efficiency perspectives. Also, both technical tools, such as the disability-adjusted life year (DALY), & local knowledge & contextual information should be used in formulating public health care policy. In Gilson's Response to Commentators, Gilson summarizes common concerns driving health care policy debates, reiterates the importance of equity over efficiency, & cautions that policy can never be truly value-free. 2 Tables, 55 References. J. Ferrari