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Types of equity in health:

For a better understanding of this concept, a practical definition is required. This definition goes “every individual must have the chance to reach his/her full health potential and no one person should be denied”. By this definition, the goal of equity in health isn’t the omission of all differences in the health of an individual and equalizing health and its quality for all, but is the omission of avoidable factors leading to inequities.
With this perspective, equity in health means:

  • equal access to care for the same need
  • equal utilization for the same need
  • equal quality for all
Equity in health from a practical point of view:
Regardless of philosophical views towards this issue, we need to determine a practical way with which we can reach equity in health. In social literature, the concept of equity is divided into two parts: Horizontal and Vertical; this was primarily suggested by Aristotle in the ancient Greek. In his explanation he defines vertical and horizontal equity as such:
– Horizontal equity: all equals must be treated the same
– Vertical equity: all in-equals must be treated differently
The definition of horizontal and vertical equity in health according to Aristotle would be:
A) Horizontal equity: receiving equal care for equal conditions; in other words equal treatments and services for the same and equal needs.

*For example Mr. A with a 400$ salary with a heart condition will receive the same treatment as Mr. B with 5000$ salary with the same heart condition.

Horizontal equity traits:

    1.  equal usage for equal needs; i.e. equal cost for nurses per bed for all ER beds.
    2. equal quality for equal needs; i.e. the same quality of hospitalization care for the same health needs.
    3. equal access for equal needs; i.e. equal waiting periods for the same health needs.
    4. equal healthcare for inequalities in health; i.e. the standard mortality rates that have been adjusted with age and gender through out the whole covered areas.
B) Vertical equity: this part of equity points out the fact that different conditions must be treated differently which is an acceptable fact in medicine because the treatment for poor eye sight isn’t the same as the needed treatment for infertility. An other aspect of vertical equity is the concern for financial needs, which points out the fact that people with more needs must receive more support. For instance in the mentioned example, due to his low income Mr. A needs financial support for both treating his condition and secondary prevention mean while Mr. B can pay for all his treatments and secondary prevention costs without any financial aid.
Vertical equity traits:
  1. in-equal treatments for different needs; i.e. the difference in treating common conditions versus critical and rare ones.
  2. progressive resource provision according to payment capabilities; i.e. progressive income taxation and exclusive resource provision from income taxation.
From the healthcare prospective these two equities are interpreted in accessibility and utilization concepts that are adjusted according to needs not social and economical status of individuals; according to this individuals with the most needs are the priority.
Need is specified by these three considerations:
  1. need as the severity of the disease
  2. need as the utilization capabilities
  3. need as the minimum resources in order to utilize services
 According to this interpretation, the goal is to give priority to those who can gain the most benefit from services, but some believe that even this ends in inequities because those who can utilize services the most are usually the richer and healthier individuals.
Regardless of various views towards equity in health, research shows an inequity in developing countries.

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