Equality of Opportunity in Health Care

Several definitions of equity in health care are accredited in health economics, as well as several (often alternative) methodologies are used for the assessment of health systems within an egalitarian perspective. Any approach is inspired by a precise statement on the ethical value judgment according to which inequalities in health care are said to be fair or unfair. This chapter discusses the main approaches to equity in health care, which are mostly grounded on the ideal of opportunity egalitarianism. Within this framework, a distinction is made between access-based and utilization-based approaches. Theories and methodologies focusing on access to health care are directly concerned with the distribution of opportunities. Differently, the latter approach considers disparities in the distribution of health care utilization and their origins (e.g., health needs, socioeconomic status) to gather information on inequality of opportunity. In turn, the utilization-based approach has been formulated in terms of horizontal and vertical equity. Some methodologies implement the Aristotelian horizontal equity principle to claim that utilization disparities among individuals with equal health needs are illegitimate. Other methodologies evoke the responsibility principle to allow for vertical equity judgments according to which all of the existing disparities can be identified as fair or unfair depending on their origins in terms of circumstances and responsible choices. Methodological implications of the main approaches to opportunity egalitarianism in health care are also discussed.