Introduction
Health care resources are represented by the facilities, personnel, funds, and all the elements used for providing medical services. Medicine is necessary for everyone, thus creating an unlimited demand for limited resources. For example, until the beginning of the 20th century, the United States allocated their health care assets according to the ability to pay, which allowed having opportunities for providing necessary help to all the population. During the past century, people became more interested in good health, which led to the appearance of different types of health insurance, including entitlement programs Medicare and Medicaid (Ransom & Olsson, 2017).
However, despite all the efforts, the demand for different aspects of medicine continues to grow and exceeds available assets. Millions of people all over the world, including the United States, do not have proper health insurance or access to medical services. Today, experts argue about the ways of the health care resources distribution, discussing the ethical side of the problem of equity and suggesting that there should be social justice, providing people the right to be healthy.
The Problems of the Medical Resources Distribution
According to numerous researches, almost all the countries face the problem of scarcity of health care resources and restrictions of access to medical services. There are documented problems with the availability of nursing homes, mental health services, and rehabilitation opportunities. The situation became more severe this year as the world struggled with a COVID-19 pandemic, which influenced the medical systems of all the countries, leading to a decrease in the number of available assets.
All the health care institutions are trying to find solutions for the proactive and ethical distribution of scarce resources. During the crisis, a health justice approach, which implies that medical services should be provided equally without regard to the social status, becomes especially important.
There is also an important principle of “social utility”, which refers to “maximizing net benefits but transferred to the field of public health” (Aguilera, 2020, para. 9). In a critical situation, this approach implies saving more lives, “which is consistent with the inherent value universally placed on each human life” (Aguilera, 2020, para. 9). Thus, the world faces a serious problem of scarcity of health care resources, which makes the concept of equity especially relevant.
Significance of Equity in Distribution of Health Care Resources
Different Meanings of Equity and Equality
It is important to understand that equity and equality in the health care sphere are not synonyms, although they are closely related. The concept of equity is “inherently normative – that is, value-based; while equality is not necessarily so” (Braveman & Gruskin, 2003, p. 255). The first notion is targeted at studying the distribution of resources which are behind health inequality, meaning a regular violation of the rights of certain groups of people.
However, not all health disparities can be considered fair since, for example, men can have prostate problems, which are not applicable to women. Meanwhile, such cases as differences in nutrition of girls and boys, or ethnic preferences in providing required treatment would be wrong from the ethical perspective. In the context of discrimination, equality becomes the priority in efforts aimed at ensuring greater fairness in health care.
Notably, in scientific terms, it is affirmed that there can be equitable inequalities. This phenomenon depends on the factors, which were defined by Aristotle in 1972 as horizontal and vertical equity (Culyer, 2015). The first notion implies that “the like treatment of like individuals and vertical equity requires the unlike treatment of unlike individuals in proportion to the differences between them” (Culyer, 2015, p. 8). These types of equity apply not only to health but to entities as well.
For example, a closely related element is the financial contribution. In this case, a horizontal principle would mean “equal contributions from households having an equal ability to pay”, while the vertical type would imply “lower/higher contributions from households with a lower/higher ability to pay” (Culyer, 2015, p. 8).
These distinctions point towards the existence of fair inequalities, meaning those which meet the conditions of vertical equity. This position was brightly expressed in the famous Marxist political slogan “from each according to their ability; to each according to their need” (Culyer, 2015, p. 8). Thus, equity and equality are different notions, being relatively close, implying various understandings of integrity and fair distribution of available resources.
Equity, Human Rights, and Social Justice
Equity is connected with the notions of social justice and human rights. First of all, it is an ethical concept impacted by the principles of justice and demanding the provision of fair services for all the population. For the purpose of measurement, equity “can be defined as the absence of systematic disparities in health between social groups who have different levels of underlying social advantage/disadvantage” (Braveman & Gruskin, 2003, p. 254).
Inequities in medicine systematically make socially disadvantaged groups of people more defenseless against the system. Health care determines social life impacted by social policies and defined by such major factors as conditions in communities, workplaces, and households. Social advantage or disadvantage is usually defined by wealth and power, which put people in different places of social hierarchies.
There are numerous factors which can influence this concept, including the level of income, occupational class, educational level, national affiliation, sexual orientation, and other characteristics. However, a health disparity associated with social advantage must be systematic, and not random. Thus, the idea of equity is linked to the concept of social justice aimed at providing everyone with fair services.
Another aspect influencing equity is the human’s right to health, fixed in all the countries’ Constitutions. According to the World Health Organization (WHO), “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, economic or social condition” (Ghebreyesus, 2017, para. 1). It implies opportunities for all people to have unlimited access to the required health services.
Meanwhile, there is an argument that in the situation of having sufficient resources, “the highest attainable standard could be far greater than that currently experienced even by the best off group in a society” (Braveman & Gruskin, 2003, p. 256). However, the state of health of the most advantaged group reflects the minimum levels that can be achieved for the entire society. Thus, this definition of equity in medicine is useful regarding the notion of the right to health, which should also consider the basic determinants of life, including the workplace and household conditions.
Possible Solutions to the Problem of the Health Care Resources Distribution Equity
Regarding the increasing situation of scarcity in the medical care sphere, there is an urgent need for developing fair allocation policies, which would protect people’s well-being. There are numerous approaches to equality, such as randomization, which may make the system look just, masking the regular inequality. When choosing prioritized patients, it is essential not to increase existing racial and socioeconomic disparities. It is also important not to base the choice on the individual’s ability to pay, as the concept of equal treatment should be preserved. The following criteria which should be taken into account for this purpose can be distinguished:
- Consider medical need, including its urgency, expected duration of benefit, the amount of resources necessary for successful treatment, and the improvement of life quality;
- Give first priority to the patients whose lives can be saved due to the treatment, then to those who will face the improvement of their life quality;
- Use objective mechanisms for determining the patients who will have access to the scarce resources;
- Explain the policies to those individuals who are denied from receiving the required care (allocating limited health care resources).
Thus, the situation of scarcity of medical resources requires using the proposed criteria of choosing preferred patients for receiving required treatment to provide a fair distribution of the available assets. These measures are necessary for situations of crisis when the medicine is limited with resources and not all the people requiring help can receive it. For this reason, there is a need to follow the basic rules to balance the decisions when selecting individuals who will be denied treatment.
Conclusion
Currently, health care all over the world faces a serious problem of fair distribution of the available resources. The recent events connected with the COVID-19 pandemic also had a negative impact on this process, contributing to the existing scarcity, while social discrimination interferes with providing necessary help to all people. The notion of equity represents a complex concept, including the ideas of social justice and the human’s right to health.
Medical care requires finding the right solution for eliminating disparities, at the same time facing the challenge of formulating the fair criteria for the proper distribution of the available resources. It is important to balance the process of medical decision-making in order to save as many lives as possible without breaking ethical norms when choosing preferred patients from all the people requiring care.
References
Aguilera, B. (2020). Ethical allocation of scarce health-care resources in the context of the COVID-19 crisis. Medwave, 20(5), 1-5. Web.
Allocating limited health care resources. (n.d.). American Medical Association. Web.
Braveman, P. & Gruskin, S. (2003). Defining equity in health. Journal of Epidemiol Community Health, 57(4), 254–258. Web.
Culyer, A.J. (2015). Efficiency, equity and equality in health and health care. Centre for Health Economics, University of York. Web.
Ghebreyesus, T.A. (2017). Health is a fundamental human right. World Health Organization. Web.
Ransom H., & Olsson J.M. (2017). Allocation of health care resources: Principles for decision-making. Pediatrics in Review, 38(7), 320-329. Web.