Equity versus efficiency: a dilemma for the NHS

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7316.762 (Published 06 October 2001) Cite this as: BMJ 2001;323:762

If the NHS is serious about equity it must offer guidance when principles conflict

  1. Franco Sassi, lecturer in health policy (f.sassi@lse.ac.uk),
  2. Julian Le Grand, Richard Titmuss professor of social policy,
  3. Luke Archard, research fellow
  1. Department of Social Policy and LSE Health and Social Care, London School of Economics and Political Science, London WC2A 2AE
  2. Health Policy Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT

    Concerns about equitable provision and financing of health care have characterised the NHS since its foundation. Evidence of persisting and, in some cases, widening health inequalities, gathered since the publication of the Black report,1 has progressively raised equity to a high rank among health policy objectives.2 Though the general aim of reducing health inequalities appears uncontroversial, the practical notions of equity that should inform policy and the ways in which these should be implemented are far from clear. Even more importantly, there is no consensus on how to deal with policies that may cause a conflict between the goals of equity and efficiency—that is, those that may improve efficiency while increasing health inequalities or improve fairness while decreasing efficiency. The equity versus efficiency dilemma3 has been virtually ignored in the political debate, often leading to inconsistent judgments in the development of health policies.

    In a report recently published by the NHS Health Technology Assessment programme4 we examined examples of the equity-efficiency dilemma that the NHS …

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