Health systems are generally assessed in terms of the degree of achievement of their objectives. These objectives comprise mainly health maximization, efficiency and equity. However, the particular characteristics of the health care market, as discussed in the previous chapter, separate health and health care from other goods and services. These peculiarities shape the objectives in health policies and thereby determine the structure; organization, financing and provision in the health system.
In discussing equity, a consideration of the distribution of wealth and income necessarily constitutes a starting point. This would involve the inherited wealth and abilities, training and education, personal capabilities and chances. An equity team in the World Health Organization (WHO) emphasized that income, employment, education, housing and health environment should be seen as the social and economic determinants of health (WHO, 2005). As these are not equally distributed in the society, the distribution of health too cannot be expected to be equal.
Therefore, one may justifiably be critical toward the WHO motto "Health for All" as set forth in the Alma-Ata Declaration of 1978 and the "Millennium Development Goals" set by the United Nations. Yet, there is an important role for the policy makers in designing health service delivery (allocation of health care resources) and the financing mechanisms ("who pays?") to improve equity in health care.
In a health system, the rules of allocation of health care resources determine access to health services; i.e. whether the individuals benefit according to their needs. Whereas, the principles of paying for health services determine whether the burden is distributed according to ability to pay. A combination of the two sets of rules described above defines the capability of responsiveness of a health system to the health care needs of its population. This capability is an indication of equity in a...