It ain’t fair

It seems that commentators (health economists, politicians, academics et al) have argued endlessly about the principles of health care in modern societies. “Is it just?” they ask. The moral argument is never satisfied. Those who argue for ‘equality’ believe that everyone is entitled, irrespective of age, gender, ethnicity, or income for example, to the same benefits. Others argue for ‘equity’ or ‘fairness’ intending that each person should have what they need, rather than necessarily the same as everyone else. But then, who decides what is needed?

One school of thought is that a ‘minimum’ standard of care should be provided to all, and what should that minimum be? Should it be greater for those who have the worst starting position? The underprivileged, or those with the poorest health? Alternatively, should the provision of care be determined as that which brings the greatest measurable health gain?

All very interesting, I hear you say, but what’s that got to do with me? From 1948 until 2006, broadly, statefinanced dental care leaned towards the first of these objectives: provide the most for those with the least. Financing more treatment for those who needed it (the ‘fee per item’ approach) tended to encourage dentists to accept patients with high dental needs, although a gradually widening gulf between the cost (to the dentist) and the fee paid by the state became an increasingly limiting factor.