PUBLIC HEALTH

Public Health and the Health System

Public Health and the Health System

Introduction

Health systems are generally assessed in terms of the degree of achievement of their objectives. These objectives comprise mainly health maximization, efficiency and equity. However, the particular characteristics of the health care market, as discussed in the previous chapter, separate health and health care from other goods and services.

The health care market forces determine the allocation of health care resources. No one has a right to health care unless it has been acquired through the market. Therefore, attempts at redistributing resources should be considered an injustice.

Thesis Statement

Equity can be evaluated by considering the distribution of the benefits and costs in the health care system. This requires the clarification of simple, but equally fundamental questions as to who gets the health gain and who pays for public health? While the former question relates to the provision of health services, the latter is concerned with the financing of them in a country. These questions, in turn, can be answered basing on certain policy preferences generally induced by the political views, social values and cultural traditions in a society. There are varying approaches to the problem of justice which may help us clarify the way we understand equity. These approaches can be classified under Libertarian and Egalitarian view.

Equity in Health Services

Defining Equity in Health Services

The Libertarians focus on the willingness and ability to pay of the individuals who are interested to increases the quality of health care system, that would ultimately result in the rationalization of health care.

Libertarian view emphasizes the role of private sector in health care and restricts the role of government in providing minimum standard of care to the poor. Hence, their criteria for equity is defined as the extent to which people are free to use the health care that they wish to use. Hence, individual preferences are important in utilization of health care decisions (Donaldson and Gerard, 1994). The Libertarian approach includes the entitlement, the decent minimum, the utilitarian and the Rawlsian maximin.

The entitlement approach, as originally argued by Robert Nozick, a libertarian philosopher involves a rejection of equality. He suggested that individuals are entitled to their true earnings or inheritance.

Measuring Equity in Finance and Provision of Health Services

There are mainly two dimensions, horizontal and vertical, in measuring equity in the provision and financing of health services. Horizontal equity implies equal treatment of equals, in other words, an equalization of risks and burdens. Vertical equity indicates unequal treatment for unequals, in other words, a progressivity (Donaldson and Gerard, 1994).

As to the assessment of equity in provision of the health services, indicators of horizontal equity are more applicable (Wagstaff and Van Doorslaer, 1993). An equitable distribution of benefits in health care requires equal treatment for equal need, irrespective of differences in ability to pay. This is referred to as horizontal equity as generally applied to the measurement of health care provision (Donaldson and Gerard, 1994). This requires equalization of specific parameters, ...