1. Ethical issues

1.3. Allocating resources

HTA assessments are often used to make decisions about the allocation of resources pertaining to healthcare. When allocating resources, care must be taken to distinguish between equal access and equitable access:

  • While the terms equity and equality may sound similar, applying the principle of equal allocation (equal access by all) can lead to an inequitable distribution of health resources and to dramatically different outcomes for those affected, especially if those resources are limited;
  • The distinction between equal and equitable access becomes clear by the definition of equity, according to the HTA glossary[1] : ’the fair allocation of resources or treatments among different individuals or groups, such that they each get what they are owed or what they are entitled to. Note: Vertical equity means that the people in the greatest need of services receive the most services, and horizontal equity means that people who have similar needs receive similar services.

  • The diagram is a depiction of the difference between equality and equity (source Allies for Reaching Community Health Equity (ARCHE)[2]).

Equal distribution of resources (the same number of crates in this scenario) does not translate to the delivery of fair, non-discriminatory health services. Only by adjusting for the individualised needs of an individual or group and resourcing a different number of crates to each person based on their personal status can disparities in the access to appropriate healthcare (apples in this scenario) within a group be eliminated. Equality does not acknowledge the possibility for a group to be composed of a mixed population of more and less advantaged members. The shortest person in the illustration only has an equal opportunity of attaining an apple when resources are distributed equitably, not equally.

[1] Other, more detailed definition: The use of resource allocation rules based on the distributive justice principle. However, the latter involves various concepts that define these rules more precisely (merit, societal value, the greater good, equal opportunity, equal treatment, priority to the most disadvantaged, standard gamble, etc.). Available at: HtaGlossary.net | equity

[2] ARCHE. Available at: https://healthequity.globalpolicysolutions.org/about-health-equity/