I see where you are coming from on this, but I do have problems with the
sort of utilitarian understanding of efficiency that you are using and which
allows for the development of inequitable but still efficient distribution
of health care resources. It feels counter-intuitive. Return to the
engineering origins of this concept and consider an example - say the
central healting in my seven room house. My aim might be to have an average
temperature through the house of 70 degrees farenheit (sorry about the
non-SI units). I would not feel that this had been achieved particularly
efficiently if five rooms reached 70 degrees, one room reached 30 degrees
and another 110 degrees.
In the public policy field in the UK if you look at the way that "Best
Value" seems to be being developed as a policy tool for investigating the
efficiency of public services "equitabilty" in one form or another is an
impoirtant measure.
----- Original Message -----
From: "Alan Williams" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, January 17, 2002 3:48 PM
Subject: Re: equity and efficiency
> Perhaps I should have been more explicit when pointing out that when
> comparing "efficiency" with "equity" I was, as I said, taking the
> efficiency objective to mean "a desire to improve overall population
> health as much as possible" and the equity objective to mean "the
> reduction of inequalities in people's lifetime experience of
> health" It is certainly possible to think of trade-offs between
> these objectives, which will be relevant to judging the effectiveness of
> particular activities, even if they purport only to be directed at one
> of the objectives. We might then say that the cost, in terms of
> worsening health inequalities, in going single-mindedly for improving
> the overall health of the entire population, is "too high".
> Conversely, in some other situation, we may say that the cost, in terms
> of sacrifices in overall population health, of going single-mindedly for
> reducing health inequalities, is too high. And this is quite
> independent of whether the particular policies we are looking at are
> "technically efficient" or not. Technically inefficient activities
> simply reduce how much you can achieve from a given budget.
>
> Alan Williams
>
> Mike Hughes wrote:
> >
> > I don't see that that you can trade-off equity for efficiency as Alan
> > suggests. In respect of the distribution of healthcare resources I would
> > have thought that one of the few reliable measures of effectiveness, and
> > thus of efficiency, was equitable distribution according to need. Thus
the
> > answer is yes it can be both. In fact it also means that health care
> > resources can't be inequitable and efficient. It does not necessarily
> > follow, however, that that all equitable services are efficient.
|