Thursday, May 12, 2011

The hidden inequity in health care

Barbara Starfield, MD, MPH - University Distinguished Professor
Department of Health Policy and Management - Johns Hopkins University
International Journal for Equity in Health April 2011, 10:15 doi:10.1186/1475-9276-10-15

Available online PDF [8p.] at:

“……Inequity is the presence of systematic and potentially remediable differences among population groups defined socially, economically, or geographically [1,2]. It is not the same as inequality, which is a much broader term, generally used in the human rights field to describe differences among individuals, some of which are not remediable (at least with current knowledge).
Some languages do not make a distinction between the two terms, which may lead to confusion and a need to clarify exact meaning in different contexts. Some people use the term “unfairness” to define inequity, but unfairness is not measurable and therefore not a useful term for policy or evaluation.

Inequity can be horizontal or vertical. Horizontal inequity indicates that people with the same needs do not have access to the same resources. Vertical inequity exists when people with greater needs are not provided with greater resources. In population surveys, similar use of services across population groups signifies inequity, because different population subgroups have different needs, some more than others. What is generally considered equity (equal use across population subgroups) is, in fact, inequity.

Most industrialized countries have achieved both horizontal and vertical equity in the use of primary care services, meaning that people with greater health needs receive more primary care services. Although some countries have achieved horizontal equity in use of specialist services, very few have achieved vertical equity because socially-deprived populations have less access to specialist services than their needs require….”

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