Topic

Equity and inequality

Equity concerns whether health, access to care and the burden of paying for it are fairly shared, as distinct from simply measured differences between groups. Inequality measures such as the concentration index, the slope index of inequality and the Kakwani index sit here, alongside distributional cost-effectiveness analysis and the equity-efficiency trade-off.

Concepts in this topic

• Acceptability of HealthcareAcceptability is the dimension of access concerned with whether people find health services culturally, socially and personally appropriate enough to use.
• Access BarrierAn access barrier is any obstacle, such as cost, distance, waiting lists or discrimination, that prevents or delays a person obtaining needed healthcare.
• Access PolicyAccess policy is the set of government or health system measures, such as coverage, user charges and waiting time rules, that shape access to healthcare.
• Access to CareAccess to care is the opportunity to obtain appropriate healthcare when needed, given the availability, location, cost and acceptability of services.
• Administrative BarrierAn administrative barrier is a paperwork, enrolment, renewal or approval requirement that deters or delays use of healthcare.
• Atkinson IndexThe Atkinson index measures inequality in health or income using a social welfare function with an explicit inequality aversion parameter, epsilon.
• Concentration CurveA concentration curve plots the cumulative share of a health variable against the cumulative share of the population ranked from poorest to richest.
• Concentration IndexThe concentration index measures socioeconomic inequality in a health variable; a negative value means it is disproportionately held by the poor.
• Distributional Cost-EffectivenessDistributional cost-effectiveness analysis (DCEA) is an economic evaluation showing who gains and loses health from a policy and its effect on inequality.
• Equity AnalysisAn assessment of whether the distribution of health, access, or financing burden across a population is fair, distinct from merely equal.
• Equity-Efficiency Trade-offThe equity-efficiency trade-off is the total health given up for a fairer distribution when the option that maximises health is not the fairest one.
• Equity-Weighted AnalysisEquity-weighted analysis is a cost-effectiveness analysis in which health gains for priority groups, such as the severely ill, are weighted more heavily.
• Extended Cost-EffectivenessA form of economic evaluation that extends standard cost-effectiveness analysis by incorporating financial risk protection and the distribution of costs and benefits by income.
• Geographic Accessibility of HealthcareAccessibility is the dimension of health care access concerned with how easily people can reach services, given location, travel time, distance and cost.
• Gini Coefficient HealthA health Gini coefficient is a scale-normalised measure of relative inequality in a specified nonnegative health variable across a population, obtained from pairwise differences or its Lorenz curve.
• Health EquityHealth equity (equity in health) means everyone has a fair chance to reach their full health potential, free of avoidable and unfair differences in health.
• Health InequalityHealth inequality is a measurable difference in health between individuals or groups, described without judging whether the difference is unfair.
• Health InequityHealth inequity is a difference in health judged avoidable, unfair and unjust, often arising from social or economic disadvantage rather than biology.
• Horizontal EquityHorizontal equity is equal treatment of equals in health care: equal care for people in equal need and equal payments from those with equal ability to pay.
• Kakwani IndexA measure of the progressivity of a tax or financing system, calculated as the concentration index of payments minus the Gini coefficient of pre-tax income.
• Reynolds-SmolenskyAn index measuring the redistributive effect of a tax or transfer system, calculated as the difference between pre-tax and post-tax income Gini coefficients.
• Slope Index of InequalityA summary measure of absolute health inequality across a socioeconomic gradient, estimated using regression across the full distribution rather than two extremes.
• Suits IndexA measure of the progressivity of a tax or financing system, using a concentration curve plotting cumulative tax burden against cumulative income.
• Theil Index HealthAn information theory based inequality measure applied to a health outcome's distribution, decomposable into inequality within and between population subgroups.
• Unmet NeedUnmet need is health care a person needed but did not receive; in drug regulation, unmet medical need is a condition without adequate treatment.
• Vertical EquityVertical equity is the principle that those in greater need should get appropriately more care, and those more able to pay should pay more.