Effectiveness, Efficiency and Equity

Health is perceived as most precious good, and people feel its vulnerability. Societies have been trying to absorb, ameliorate or compensate consequences and health risks with varying emphasis and varying success. Due to the uniqueness of good health to a persons’ ability to live the life he or she wants, health care and performance of health care systems are under critical observation. In this context many discussions swivel around ethics, justice, equity, equality and fairness, very often using these notions interchangeably. Sometimes they are used as arguments to challenge every economic consideration by claiming “the freedom of therapeutic choices”, and pointing out the humanitarian aspect of an individual’s health and the danger of withholding intervention options or rationing. It is not surprising to see, that many health care professionals and patients see a certain incompatibility between financing, operational aspects of health care, like allocation of resources, and ethical expectations. Nevertheless, this is not necessarily so. In the following we will discuss what principles should rule a health care system. Furthermore conflicts and trade-offs between performance measures like effectiveness and efficiency and equity considerations will be discussed.