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Key Issues in Conceptualization

Equity is not defined by preferences but by values of judgments. Although several definitions leave an open interpretation to equity allowing for several perspectives, the majority takes an egalitarian viewpoint of social justice. “Access” and “need” are terms which are difficult to conceptualize and measure.


  • Equity: “The absence of avoidable or remediable differences among populations or groups defined socially, economically, demographically or geographically (WHO)”.
  • Equity: “Ensuring access to care based on need and not ability to pay (WHO, 2000)”.
  • Equity in access: “From the egalitarian perspective, a publicly financed system should offer equal opportunities of access for those in equal need, independent of ability to pay. From the libertarian perspective, access to health care is a part of a part of society’s reward system at the margin at least, people should be able to use their income and wealth to get more or better health care than their fellow citizens if they so wish. (Williams, 1993)”
  • Equity: “Horizontal equity requires the like treatment of like individuals and vertical equity requires the unlike treatment of unlike individuals, in proportion to the differences between them. (Culyer 2001)”
  • Equity: “Horizontal equity requires equal treatment to those of equal merit, and vertical equity requires more favourable treatment of those with greater merit (Mooney, 1983)”.
  • Equity: “The extent to which disparities or inequalities in health among subgroups of the population are minimized. Substantive equity is reflected in subgroup disparities in health. Procedural equity refers to the extent to which the structure, process, or procedures intended to reduce these disparities may be judged to be fair, grounded in norms of deliberative, distributive, and social justice (Aday et al, 1981).”

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