


Equity in healthcare refers to the even distribution of access and services across a given group.  Inequality and inequity are not necessarily the same thing.  If inequality, among say the rich and the poor are due to financial or time constraints (i.e. the poor cannot afford certain services) it can be said that it that is an inequity.  However, if there is an inequality due to consumer preferences (for example, increased utilization by the poor because they need healthcare services more), this is an inequality that does not indicate inequity.  As can be noted in the above example, inequality may not always be in favor of the rich.  In fact, as Rawl's notes, inequality should only be allowed in raising the status of the poor. 
	In discussing equity, it is important to note that there are two aspects that need to be analyzed: vertical equity and horizontal equity.  Vertical equity is the distribution of services across income levels .  In other words, do the richest citizens have the same level of access compared to the poorest?  When looking at health systems which rely on out-of-pocket spending, equity is usually affected, with co-payments and premiums affecting access by the poorest citizens more so than the richest.  Another example of vertical equity concerns healthcare financing.  Financing the system via income taxes, say, is considered a vertically equitable financing mechanism, as the amount contributed is directly proportionate to a citizen's income.  Sales taxes, on the other hand, would be a larger burden on the poor than the rich, and as such is not vertically equitable.
	Horizontal equity refers to the distribution of services across different regions of an area, usually a country.  Of particular interest here is access in urban areas vs. access in rural areas.  Generally, healthcare is more easily accessible to those in urban areas, where one usually finds more healthcare providers.  There are knobs by which governments can effect horizontal equity, namely through financing options, providing more money to rural providers to incentivize serving communities that traditionally have less access.  Governments can also facilitate community-based health insurance schemes to help those in marginal areas increase access.  CBHIs, however, may not always be vertically equitable, as the poorest are still often unable to pay premiums for service.
	Governments should keep equity in mind when discussion health systems solutions.  In fact, one might say it is the basis of the liberal approach to healthcare.  As a rule, egalitarian liberalism is primarily concerned with equal access.  There are a number of “control knobs” available to governments to affect equality, namely financing (how funds are collected for services, out of pocket vs. tax-collection), payment (how providers are paid for services provided), and regulation (establishing a basic package of services, for example).
	Equity's relationship with efficiency is an important aspect for governments to consider as well. 