FinOHTA, STAKES, Finland

Within an HTA project equity can be defined as fairness when allocating resources and interventions among individuals or groups. Equity issues are important both in relation to needs and access to services. Equity as an ethical imperative has to be taken into account when organizing health care systems, setting goals, and allocating health care resources.

It is important that decision makers understand that they hold equity assumptions, which are likely to have implications to their decisions. They have to think which individuals or population groups may benefit from a health intervention or perhaps be penalised by that intervention. Population characteristics such as age, gender, ethnicity, geographical area, socioeconomic conditions, or health status may be relevant for equity purposes.

Due to limited health care resources it is not possible to afford everything. Equity includes also the right to get effective and safe treatment.

Choosing outcome measures may have equity implications. For example the use of QALY as an outcome measure implies that each unit of measurement is considered equal regardless of who gains. By using QALYs, it is assumed that a small gain to many people is equally desirable as a large gain to a few as long as the QALY totals are the same.

One example of the use of equity is reported by Teperi et al. (2006)(http://www.stakes.fi/verkkojulkaisut/raportit/M233-VERKKO.pdf) where they concluded that allocating services has not happened according to equity principles. In relation to needs, well paid people get more surgical treatments, physical examinations and psychotherapy.