Efficiency, equity and equality in health and health care

Three common “Es” have high ethical and political content for health policy: efficiency, equity and equality. This article examines the links between the three, with especial attention given to (a) the claimed conflict between efficiency and equity, (b) the equity of inequalities and (c) the conflict between six equity principles: equal health, equal health gain, equal value of additional health, maintaining existing distributions, allocation according to need and equal per capita resources. Conclusions include: Efficiency and equity do not inherently conflict  an inefficient allocation can be equitable  an efficient allocation can be inequitable  an inefficient allocation can become more efficient without increasing inequity  what is equitable often requires inequality in health and inequality in resource distribution per capita  equality in health requires inequality in resource allocation  equality in resource allocation typically leads to inequality in health  allocation according to need typically leads to inequality in health