Abstract
In the health systems literature one can see discussions about the trade off between the equity achievable by the system and its efficiency. Essentially it is argued that as greater health equity is achieved, so the level of efficiency will diminish. This argument is borrowed from economics literature on market efficiency. In the application of the economic argument to health, however, serious errors have been made, because it is quite reasonable to talk of both health equity being a desirable output of a health system, and the efficient production of that output. In this article we discuss notions of efficiency, and the equity-efficiency trade off, before considering the implications of this for health systems.
Highlights
What is more important, a health system that delivers equitable health outcomes or an efficient health system? This meaningless question lies at the heart of the “equity-efficiency trade off.” It is semantically badly formed and the only response it should elicit is one of confusion or bemusement
The consequences of the semantic error have, we argue, misdirected efforts to develop efficient health systems
Efficiency as an idea draws on the notion of useful work or sought outputs, with its origins in physics and engineering, and the transformation of heat energy into mechanical energy [9]
Summary
A health system that delivers equitable health outcomes or an efficient health system? This meaningless question lies at the heart of the “equity-efficiency trade off.” It is semantically badly formed and the only response it should elicit is one of confusion or bemusement. This meaningless question lies at the heart of the “equity-efficiency trade off.”. A health system that delivers equitable health outcomes or an efficient health system? It is semantically badly formed and the only response it should elicit is one of confusion or bemusement. A more appropriate question would be, “what is more important for a population, a health system that delivers equitable (fairly distributed) health outcomes or a health system that maximises health gains?” The difference between the meaningless first question (which does not contrast outcomes) and the potentially meaningful second question (which does contrast outcomes) is critical. To bring clarity to the matter we revisit notions of efficiency, the equity-efficiency trade off, and the consequences of this for the efficient health systems
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