Elsevier

Health Policy

Volume 35, Issue 3, March 1996, Pages 205-216
Health Policy

An epidemiological approach towards measuring the trade-off between equity and efficiency in health policy

https://doi.org/10.1016/0168-8510(95)00783-0Get rights and content

Abstract

The concept of social welfare functions has been discussed in health economic literature, as it provides a way of examining the extent to which society is prepared to accept a trade-off between efficiency and equity. In this paper requirements for meaningful empirical estimates of the willingness to accept lower per capita health status in order to achieve greater equity are examined. Results from a pilot study aimed at testing the proposed measurement procedure are reported. They show that at least two thirds of the politicians who participated are prepared to accept a lower growth in per capita health in exchange for increased equity. Accordingly, we found a weak empirical support for the common health economic assumption that only total health benefit should guide the use of resources.

References (41)

  • M. Lockwood

    Quality of life and resource allocation

  • World Health Organization

    Targets for health for all 2000. Targets in support of the European regional strategy for health for all

    (1985)
  • J. Rawls
  • R. Dworkin

    What is equality?

    Philosophy and Public Affairs

    (1981)
    R. Dworkin

    What is equality?

    Philosophy and Public Affairs

    (1981)
  • M.F. Drummond

    Allocating resources

    International Journal of Technology Assessment in Health Care

    (1990)
  • M.C. Weinstein

    Principles of cost-effective resource allocation in health care organizations

    International Journal of Technology Assessment in Health Care

    (1990)
  • C.A. Blades et al.

    Health services efficiency: appraising the appraisers—a critical review of economic appraisal in practice

    Social Science and Medicine

    (1987)
  • J. Townsend et al.

    Cigarette smoking by socioeconomic group, sex, and age: effects of price income, and health publicity

    British Medical Journal

    (1994)
  • D.G. Altman et al.

    The cost-effectiveness of three smoking cessation programs

    American Journal of Public Health

    (1987)
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