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Is it not time for health economists to rethink equity and access?

Published online by Cambridge University Press:  01 April 2009

GAVIN MOONEY
GAVIN MOONEY*
Affiliation:
Professor of Health Economics, Curtin University, Australia and Honorary Professor, Health Economics Unit, University of Cape Town, South Africa
*
*Correspondence to: Professor Gavin Mooney, Curtin University, GPO Box U1987, Perth WA 6845, Australia. Email: [email protected]
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Abstract

This article considers two key issues in health economics regarding the question of equity. First, why have health economists not resolved better the issue of what are equity and access? Second, the paper draws attention to the relative lack of analyses of equity concerns outside of health care. The question of whose values should prevail in equity is also addressed. On the first issue, there is an obsession with quantification in economics with the result that in analysing equity, in practice often ‘use’ has been substituted for ‘access’. The problem of defining access has thereby been by-passed. This has taken the pressure off trying to research access per se. Second, what is meant by equity and access are in part culturally determined. The continued efforts of health economists to treat equity as some universal construct are misplaced. The lack of effort on the part of health economists to look at equity more broadly than health care equity is concerning. Certainly, to be pursued in practice, equity in both health and health care need a shift in resources, which will be opposed by those who exercise power over decision making in health care and in society more generally. Currently health economists’ analyses say all too little about power and property rights in health care and in society. It is argued that the relevant citizens or communities which a health service serves are best placed to judge the access barriers they face and their relative heights. A useful definition of equity established by a citizens’ jury in Perth, Australia is used to exemplify this point. It is concluded that the often all too simplistic equity goals adopted in health economics (and sometimes public health discourse) need to be challenged. For health economists, there is a need for more of us to get involved in the issues around inequalities, class and power and the impact of these on health.

Type
Special Section on Access to Health Care
Information
Health Economics, Policy and Law , Volume 4 , Issue 2 , April 2009 , pp. 209 - 221
Copyright
Copyright © Cambridge University Press 2009

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