Equity and equality in health and health care

J Health Econ. 1993 Dec;12(4):431-57. doi: 10.1016/0167-6296(93)90004-x.


This paper explores four definitions of equity in health care: equality of utilization, distribution according to need, equality of access, and equality of health. We argue that the definitions of 'need' in the literature are inadequate and propose a new definition. We also argue that, irrespective of how need and access are defined, the four definitions of equity are, in general, mutually incompatible. In contrast to previous authors, we suggest that equality of health should be the dominant principle and that equity in health care should therefore entail distributing care in such a way as to get as close as is feasible to an equal distribution of health.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cost-Benefit Analysis / statistics & numerical data
  • Data Collection
  • Health Care Rationing / economics
  • Health Care Rationing / standards
  • Health Expenditures*
  • Health Services Accessibility / economics*
  • Health Services Accessibility / statistics & numerical data
  • Health Services Needs and Demand / economics*
  • Health Services Needs and Demand / statistics & numerical data
  • Health Services Research
  • Models, Statistical
  • Resource Allocation*
  • Social Justice / economics*
  • United Kingdom