In many cases, it is possible that the largest health gain may not result from services directed to those who are less well off or in poorer health. A trade-off is often necessary between efficiency (in the sense of maximising some index of health) and a more equal or fairer distribution of services. This trade-off is not easy. It is necessary to have a clear and agreed concept of equity, the ability to measure equity and an agreed basis for the extent to which equity factors will be weighted in the choice process. It is also important to be clear whether the inequity in any system is the result of a failure to pursue efficiency properly, or whether equity and efficiency must be traded off. This chapter explores the difficulties in this area.
Normand, C. Making the trade-off between efficiency and equity. In: Getting health economics into practice. (2002) 237-246. ISBN 9781857755756, 1857755758