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Joko Mulyanto BHL 3 - 2009

Definition  Justice according to natural law or right. impartial. Equity is fairness  The concept of equity based on social justice theories . which depend on the ideology of society . . or quality of being just. ideal.  The state. specifically: freedom from bias or favoritism. and fair.  Equity ≠ Equality  Equality is sameness.

Ideological Perspective of Equity  Equity vs.  Libertarian vies vs. Altruism  Altruism is about preferences. Egalitarian view  Libertarian view of equity: distribution according to financial ability  Marxist /socialist/ egalitarian view of equity: distribution according to need . Equity is about a person’s right.

Progressive financing system .Unequal treatment for unequal need .Equal access for equal need .Equal treatment for equal need  Vertical equity : the allocation of different resources for different levels of need .Operational Definition  Horizontal equity : the allocation of equal or equivalent resources for equal need .

 What is need ? the amount of resources required to exhaust capacity to benefit .Access and Need  What is access ? the maximum attainable level of consumption of medical care. and the time and money prices associated with consuming medical care. given the individual’s income.

 Equity in health outcome. delivery and financing of healthcare.Equity of What ?  Equity in access of healthcare. is it possible ? .

Equity principles in the delivery of healthcare  Healthcare should be distributed according to people’s need not their ability to pay.  Health is basic need and right for people. .  Why healthcare?  Healthcare is the instrument to achieve health.  Health is consider as the condition for people’s functioning and well being.

Equity principles in ability to pay  Healthcare should be financed according to their ability to pay.  Decoupling payment from utilization  Progressive payment .

So. are also considered unfair and unjust. Inequity of health  The term inequity has a moral and ethical dimension. It refers to differences which are unnecessary and avoidable but. the cause has to be examined and judged to be unfair in the context of what is going on in therest of society. in order to describe a certain situation as inequitable. in addition. .Equity in Health Outcome  Equity in access of healthcare not automatically resulted in fair distribution of health outcome.

more pragmatically. . Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and. that no one should be disadvantaged from achieving this potential. if it can be avoided.

biological variation. Health-damaging behaviour if freely chosen.  Health-damaging behaviour where the degree of choice of lifestyles is severely restricted. stressful living and working conditions. such as participation in certain sports and pastimes.  Exposure to unhealthy.Determinants of Health Disparities  Natural.   The transient health advantage of one group over another when that group is first to adopt ahealth-promoting behaviour (as long as other groups have the means to catch up fairly soon).  Inadequate access to essential health and other public services. .  Natural selection or health-related social mobility involving the tendency for sick people to move down the social scale.

 There is link between disparities and responsible agent.  The disparities is not reflect free choice.Criteria of Health Inequity  The disparities is avoidable. .

greater. .  Financially avoidable There are sufficient resources exist to satisfy fair condition.Avoidability  Technically avoidable Current science and knowledge provides proven successful intervention. sense of justice.  Morally avoidable the proposed redistributionwould not violate some other.

Choice  Sufficient resources to establish free choice  Legal right to utilize the resources .

 Culpable entity  Accountable entity .Agency  Responsible agent.

Spectrum of Disparities .

have the opportunity to access those sanitary and social measures necessary to protect. similarly the inequities in health determinants are those that should not exist. therefore. As is the case with health outcomes. Every person should.Concluding Remarks Equity refers to differences that are unnecessary or reducible and are unfair and unjust. in terms of equity. promote and maintain or recover health (Sir George Alleyne) . The concept of fairness obviously involves a moral judgement and is. intrinsically difficult.