This paper weighs up the efficiency-equity debate from the health economics perspective. It contends that as currently available qualitative and quantitative methods designed to incorporate equity into economic evaluation are beset by definitional uncertainties and other inherent limitations, no method has been universally adopted to date. The researchers propose a concept that may overcome some of those limitations; a cost-based equity weight for evaluating the cost side as opposed to the outcomes side of interventions delivered by primary health care programmes. As this concept focuses on achieving equity in processes rather than outcomes, it is sensitive to the context and health beliefs of target groups. The researchers evaluate primary health care delivery to the Australian Aboriginal and Torres Strait Islander (or Indigenous) population, as an illustrative case study. The ‘equity of access’ decision-making tool is a potentially important avenue for further health economics research, conclude the researchers.
Not being a health economist, many of the concepts discussed in this paper were new to me. However, there is increasing interest in the area of health, economy and equity. As Gareth Morgan argues in his new book ‘Health Cheque’, an investment in reducing health inequalities now will have long-term benefits for all new Zealanders (see his website and prescription at www.healthcheque.co.nz).
Independent commentary by Dr. Matire Hardwood
Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.
Research Review publications are intended for New Zealand health professionals.
Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.
