EQUITABLE CARE THEORY

Introduction

As the government and international organizations renewed their commitment to improve

the health of poor and marginalized people, people paid more attention to the fairness of health
and medical care (Gwatkin 2019). Equity is one of the basic principles of primary health care,
implicitly or explicitly in the health care policies of most countries.

Equity is an abstract concept that encompasses philosophical issues such as fairness and
social justice, makes its definition and measurement very complicated. Before John Rawls' A
Theory of Justice (2017), researchers mainly evaluated the justice or fairness in the social
distribution based on the distribution of results. Since then, the concept of has undergone major
changes: Rawls’ "difference principle" seeks to maximize the availability of commodities for
disadvantaged groups; Sen (2019) talks about capabilities from the perspective of the set of
possible functions enjoyed by individuals, And emphasized the distribution of capabilities;
Dworkin (2018) equated justice with the equality of resources, not results; and Roemer (2018)
emphasized equality of opportunity. This evolution of social justice theory in the past 30 years is
about moving away from actual after-event results (such as income) and its impact on personal
well-being, and moving the bet (as ability or opportunities) toward the potential result set.

Equity related to health and medical care can be viewed from three broad perspectives: (i)
Equity in health, (ii) Equity in the provision of health services, and (iii) Equity in health
financing. Although all three are covered in this investigation, the first two constitute the focus
of this investigation. In this context, it is important to discuss the operational definitions of (i)
and (ii).

Health equity is defined as the minimization of avoidable health inequalities and their
determinants, which occur between people with different levels of potential social advantages or
privileges. Inequality exists when there are differences in health and well-being care and its
determinants that are considered avoidable, unfair, and unfair. Therefore, not all inequalities in
health between population groups are considered inequalities. Inequality in health and medical
care specifically refers to the differences between groups of people related to their social status,
and these differences are measured by characteristics such as income or wealth, occupation,
education, geographic location, gender or race. health inequality caused by unavoidable and
inevitable conditions, such as biological and genetic variation, does not constitute.

Theoretical Framework
 Measuring the fairness of healthcare is a real challenge, especially because there is no
consensus on how to define and measure this concept. In the literature on the conceptualization
of fairness, can find some common foundations through the understanding of the three fields: 1st,
people with equal needs receive equal care 2nd, people with equal needs equal treatment and 3rd,
The result of equal treatment of people with the same needs is. Although the nature of fairness is
oversimplified, the definition provided by these three domains is a useful framework that
outlines the possible inequalities of in the healthcare sector.

Regarding access to health care, the definition of the concept depends to a large extent
on the context in which is being analyzed. Goddard and Smith defined the opportunity to obtain
medical care as "the ability to ensure that a specific service area has a specific level of quality, is
affected by a specific maximum degree of inconvenience and personal cost, and at the same time
has a specific level of information". Regarding the scope of the services provided, the Equity
Literature extends the aspect of “providing equal services for people with the same needs”. This
refers to the fact that factors such as age, gender, and income should not require people with
similar needs to enter different doors (for example, public providers) or that they are treated
differently. Services provided. Service quality is also an inherent element of the visit, because in
terms of the structure of the, the care provided, or the results, poor quality may affect the visit.
Regarding personal discomfort, cost, and information, there may be considerable differences in
the personal costs of using services (such as user fees and transportation costs) and the
understanding of availability and usability. The effectiveness of the service (for example,
because of language or cultural differences). Although cannot completely match these aspects, in
some aspects, the difference in cost and information distribution will become unacceptable. The
patient-provider interaction plays an important role in the assessment of the fairness of treatment
and treatment outcomes. The changes produced by this interaction depend on the knowledge,
skills, preferences, perceptions, attitudes, and prejudices of the patient and the healthcare
provider. In addition, the broader social determinants of health, such as the social environment in
which people live and work, may lead to unfair treatment and treatment outcomes. For example,
the unequal recovery rate of among different social groups may occur even if there is no
inequality in their access or treatment.

Discussion

In developing the equity standards, the project group identified five main areas that should be
addressed to ensure the delivery of equitable services in healthcare:

Standard 1: Equity in Policy

Standard 2: Equitable Access and Utilization

Standard 3: Equitable Quality of Care

Standard 4: Equity in Participation

Standard 5: Promoting Equity

The first standard, Equity in Policy Its objective is to promote equity by providing fair

opportunities, reducing health inequalities, and providing sustainable and profitable policies.

This standard aims to ensure that a fair strategy is developed and that the implementation of is

integrated into all relevant organizational plans and quality management systems. Therefore, all

monitoring systems and evaluation processes should reflect and support equity policy measures.

In addition, the continuous development of the workforce should be promoted to achieve

profound institutional changes towards equity, especially regarding the measures taken to raise

awareness about the impact of insufficient access and discrimination.

 The goal of the second standard, Equitable Access and Utilization, It is to encourage

WHO to address the barriers that prevent people from accessing and benefiting from health care

services. On the one hand, it is necessary to guarantee physical accessibility and the geographic

distribution of services and facilities, including outreach interventions for the most vulnerable

groups. On the other hand, effective intervention is needed to improve communication and

information. With regard to language barriers, a lot of work has been done and needs to be

consolidated and maintained, but more attention must be paid to the information intervention to

solve health literacy. This standard encourages healthcare organizations to address more difficult

obstacles, such as the power imbalance in communication between patients and doctors, and to

increase trust, respect, openness and empathy in the relationship with patients. Other difficult

obstacles are legal and financial, depending on the rules outside health services, such as the lack

of formal rights or insurance coverage. However, the standard encourages healthcare

organizations take action where eligibility rules compromise human rights, suggesting that

concrete solutions be provided to ensure that ineligible people receive appropriate information,

care and support.

The aim of the third standard, Equitable Quality of Care, the organization offers high

quality terms, and always approves the unique personal features and plays these to improve your

health and happiness. Health Suppliers should be able to take into account individual experiences

and opinions in maintenance management of the care process from diagnosis to the hospital.

Therefore, in the case of immigrants, suppliers are taught by customs, and preparing the value of

a specific ethnic minority culture to people can respond to the needs of multiple diversity.

Instead, all levels of health personnel work that act beyond differences and learn to invest in the

relationship with to create other knowledge. This approach helps to understand the intersections
of racial, ethnic, gender, classes, and eliminate the relationship and influence of this intersection

in relation to the experience of current disease. Only patients are only to help.

The fourth standard, Equity in Participation, aims to ensure that service users and

community members have a fair opportunity to participate in the planning, delivery and

evaluation of the service. Promoting active participation does not mean that only establishes

contacts with well-organized community groups, which may not represent the needs of

individuals or the needs of groups that are smaller, less organized, or completely marginalized.

By assuming that “community groups” are always homogenous entities whose members share

interests, values and identities, we may ignore the fact that communities are related to gender,

race, ethnicity, religion, and economic status. The difference, can produce a relationship that

isolates specific individuals, denying them an equal voice or not even being able to participate.

Therefore, the main purpose of this standard is to ensure that individuals and social groups who

are at risk of being excluded by participate in general participation activities.

The fifth standard, Promoting Equity, promotes organizations' commitment to promote

fairness activities in other sectors of society. Organizations should actively participate in equity-

related networks, think tanks, and research programs, such as partnerships that provide

innovative services to vulnerable groups and cross-sector cooperation to address broader health

determinants.
Nursing Paradigm

The environment includes the internal and external variables, as well as events and

issues that influence both the nurse and the patient. The external variables provide nurses with

significant opportunities to hone their knowledge, gain relevant experience, and create a unique

relationship with the patient. The internal conditions include variables within the nurse that can

impact the outcome of the care provided to the patient. These variables include the nurse's

knowledge and experiences, sincere interest to care or a caring attitude for the patient, and

receptivity to different forms of knowing. The synergy of these variables in the external and

internal environment affects the nurse by facilitating the development and use of the nurse’s

intuitive skill (as shown by the arrow connecting the environment and the nurse).

Variables in the patient's internal and external environment are all part of the patient's

experience which can bring about either a positive or negative patient situation (as shown by the

arrow connecting the environment and the patient). Favorable events and issues, correct
knowledge, and good experience result in a positive patient situation while unfavorable events

and issues, faulty knowledge, and bad experience result in a negative patient situation. The latter

gives rise to a health need or situation that requires the intervention of the nurse.

To enhance the use of intuition, a deep connection between the nurse and the patient is

crucial. This connection is built through a genuine nurse-patient relationship which enables the

nurse to understand the patient’s situation holistically. Intuition, therefore, is a valid form of

knowing that guides the nurse in performing nursing actions to address the health needs of the

patient (as shown by the arrow connecting the nurse and the patient) and result to positive health

outcomes (as shown by the arrow connecting the patient and the health). It is the ultimate goal of

the nurse to bring about positive health outcomes.

Lastly, when the patient is able to meet his/her needs through the help of the nurse, a

positive health outcome is achieved. A positive health outcome resulting from nurses’ intuitive

skill serves as a positive feedback and a motivation for nurses to further develop and promote

this form of knowing in their practice (as shown by the arrow connecting the health and the

nurse).

Conclusion

Impact on health policy, quality of care, and equity is applicable to many health care

systems. When evaluating health system reform, the first thing to consider is the degree to which

different groups of people enter the health system. Not only is coverage important, but it is also

important to have a more detailed understanding of differentiated use of services and the barriers

patients encounter in getting the care they need. Therefore, it is important to pay attention to non-

financial barriers such as system transparency, caregiver characteristics, and waiting lists.
Qualitative research presenting the views and experience of care providers and patients can help

explain the mechanisms that led to the observed differences. Second, differentiated goals for

specific patient groups must be taken into account. Without them, equal achievement levels can

give an impression of equity in care when in fact there may be inequality (for example, due to

the different prevalence of hypertension among different races, the rate of blood pressure

measurement of different races may be equal Show that there is inequality in health). Third, it is

important to find indicators that include complexity. In this case, non-disease-specific and

patient-centered indicators (such as functional status and quality of life) may be useful. Fourth, it

is essential to collect information at the patient level and create possibilities to monitor the

trajectory of personal healthcare utilization. Finally, plans in a broader health system impact

assessment strategy, where equity is as important a criterion as cost-effectiveness and other

criteria. The conceptual framework provided in this article is a guide for developing new

evidence and using existing evidence to assess equity in the health system.
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