Most agree health disparities are a moral problem. Yet there are disagreements about how to reduce them. Some believe that in health systems, equity and efficiency are incompatible, requiring stark and painful tradeoffs. Others, myself included, believe that achieving equitable health outcomes can, in fact, be accomplished by improving efficiency.
The existing structure of the US health system – including how it’s organized and paid for — is designed to increase health gains irrespective of whether those gains are maintained and concentrated in a subset of the overall population – such as the wealthy, for example. Despite the inefficiencies in the system, it was, nevertheless, designed with efficiency in mind. In this case, efficiency serves the production, intentionally or not, of inequitable outcomes. Equity is treated as a complementary rather than central goal of the system. Even among the 6 domains of health care quality established by the Institute of Medicine, equitable care and efficient care are listed as separate domains. Some may argue that the goals of effectiveness, safety, timeliness, and patient centeredness – measured more often – are more important or more feasible to address.
Even so, this does not mean we should accept the status quo. To do so, would involve overlooking several factors: 1) equity and efficiency are not at odds, 2) ignoring health inequities entails a significant opportunity cost, and 3) increasing equity is necessary for long-term prosperity both socially and economically.