Edited by Alistair McGuire and Joan Costa-Font
Chapter 1: Inequalities in Health: Why Do We Care? How Do We Care? What Can We Do About Them?
Cristina Hernández-Quevedo and Joan Costa-Font 1. INTRODUCTION A widely accepted governmental goal in Western countries is that individuals should enjoy good health, through ensuring equitable access to health irrespective of each individual’s social position. This takes place primarily by lowering (and ideally removing) barriers to health care access so as to reduce the socioeconomic vector in health access and financing, and thus achieve health equity standards. The World Health Organization performance framework, introduced in The World Health Report (2000), establishes that the main goals of a health care system are: health attainment, by ensuring access to care; responsiveness to population needs from health care services; and a fair distribution of financing. To accomplish health equity goals, health systems typically design programmes and institutions that attempt to lower existing barriers to health care, primarily those affecting its financing and general access – and to a lesser extent preventive programmes. Fairness in health financing is addressed by providing comprehensive coverage and limiting the use of direct payments. Similarly, barriers to health care access are normally addressed through programmes that improve the delivery of health care and prevention, although public programmes are seldom capable of dealing with pre-existing unequal conditions. Equity in health, however, has been considered an undesirable policy objective because it would impose many restrictions on individuals’ choice of how to live their lives (Oliver and Mossialos, 2004). Hence interest focuses on the differences of levels of health outcomes across individuals with different socioeconomic characteristics, such as income, job status, education...
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