equity in healthcare
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EQUITY IN HEALTHCARE
Joko MulyantoBHL 3 - 2009
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Definition
Justice according to natural law or right;specifically: freedom from bias or favoritism.
The state, ideal, or quality of being just,impartial, and fair.
Equity Equality
Equality is sameness, Equity is fairness The concept of equity based on social justice
theories , which depend on the ideology ofsociety .
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Ideological Perspective of Equity
Equity vs. Altruism
Altruism is about preferences; Equity is about
a persons right. Libertarian vies vs. Egalitarian view
Libertarian view of equity: distribution
according to financial ability Marxist /socialist/ egalitarian view of equity:
distribution according to need
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Operational Definition
Horizontal equity : the allocation of equal orequivalent resources for equal need
- Equal access for equal need- Equal treatment for equal need
Vertical equity : the allocation of different
resources for different levels of need- Unequal treatment for unequal need
- Progressive financing system
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Equity of What ?
Equity in access of healthcare; delivery andfinancing of healthcare.
Equity in health outcome; is it possible ?
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Equity principles in the
delivery of healthcare Healthcare should be distributed according to
peoples need not their ability to pay.
Why healthcare? Healthcare is the instrument to achieve
health.
Health is consider as the condition forpeoples functioning and well being.
Health is basic need and right for people.
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Equity principles in ability to
pay Healthcare should be financed according to
their ability to pay.
Decoupling payment from utilization Progressive payment
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Equity in Health Outcome
Equity in access of healthcare not automaticallyresulted in fair distribution of health outcome;Inequity of health
The term inequity has a moral and ethicaldimension. It refers to differences which areunnecessary and avoidable but, in addition, are alsoconsidered unfair and unjust. So, in order to describe
a certain situation as inequitable, the cause has to beexamined and judged to be unfair in the context ofwhat is going on in therest of society.
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Equity in health implies that ideally everyoneshould have a fair opportunity to attain theirfull health potential and, more pragmatically,that no one should be disadvantaged fromachieving this potential, if it can be avoided.
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Determinants of Health
Disparities Natural, biological variation.
Health-damaging behaviour if freely chosen, such as participation incertain sports and pastimes.
The transient health advantage of one group over another when thatgroup is first to adopt ahealth-promoting behaviour (as long as othergroups have the means to catch up fairly soon).
Health-damaging behaviour where the degree of choice of lifestylesis severely restricted.
Exposure to unhealthy, stressful living and working conditions.
Inadequate access to essential health and other public services.
Natural selection or health-related social mobility involving thetendency for sick people to move down the social scale.
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Criteria of Health Inequity
The disparities is avoidable.
The disparities is not reflect free choice.
There is link between disparities andresponsible agent.
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Avoidability
Technically avoidable
Current science and knowledge provides
proven successful intervention. Financially avoidable
There are sufficient resources exist to satisfyfair condition.
Morally avoidable
the proposed redistributionwould not violatesome other, greater, sense of justice.
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Choice
Sufficient resources to establish free choice
Legal right to utilize the resources
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Agency
Responsible agent;
Culpable entity
Accountable entity
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Spectrum of Disparities
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Concluding Remarks
Equity refers to differences that are unnecessary or
reducible and are unfair and unjust. The concept offairness obviously involves a moral judgement and is,
therefore, intrinsically difficult. As is the case withhealth outcomes, similarly the inequities in healthdeterminants are those that should not exist. Everyperson should, in terms of equity, have the opportunityto access those sanitary and social measures necessaryto protect, promote and maintain or recover health
(Sir George Alleyne)