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A cost-based equity weight for use in the economic evaluation of primary health care interventions: case study of the Australian Indigenous population

Ong, Katherine S., Kelaher, Margaret, Anderson, Ian and Carter, Rob 2009, A cost-based equity weight for use in the economic evaluation of primary health care interventions: case study of the Australian Indigenous population, International journal for equity in health, vol. 8, no. 34, pp. 1-14.

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Title A cost-based equity weight for use in the economic evaluation of primary health care interventions: case study of the Australian Indigenous population
Author(s) Ong, Katherine S.
Kelaher, Margaret
Anderson, Ian
Carter, Rob
Journal name International journal for equity in health
Volume number 8
Issue number 34
Start page 1
End page 14
Total pages 14
Publisher BioMed Central Ltd.
Place of publication London, England
Publication date 2009-10
ISSN 1475-9276
Summary Background : Efficiency and equity are both important policy objectives in resource allocation. The discipline of health economics has traditionally focused on maximising efficiency, however addressing inequities in health also requires consideration. Methods to incorporate equity within economic evaluation techniques range from qualitative judgements to quantitative outcomes-based equity weights. Yet, due to definitional uncertainties and other inherent limitations, no method has been universally adopted to date. This paper proposes an alternative cost-based equity weight for use in the economic evaluation of interventions delivered from primary health care services.

Methods :
Equity is defined in terms of 'access' to health services, with the vertical equity objective to achieve 'equitable access for unequal need'. Using the Australian Indigenous population as an illustrative case study, the magnitude of the equity weight is constructed using the ratio of the costs of providing specific interventions via Indigenous primary health care services compared with the costs of the same interventions delivered via mainstream services. Applying this weight to the costs of subsequent interventions deflates the costs of provision via Indigenous health services, and thus makes comparisons with mainstream more equitable when applied during economic evaluation.

Results :
Based on achieving 'equitable access', existing measures of health inequity are suitable for establishing 'need', however the magnitude of health inequity is not necessarily proportional to the magnitude of resources required to redress it. Rather, equitable access may be better measured using appropriate methods of health service delivery for the target group. 'Equity of access' also suggests a focus on the processes of providing equitable health care rather than on outcomes, and therefore supports application of equity weights to the cost side rather than the outcomes side of the economic equation.

Conclusion : Cost-based weights have the potential to provide a pragmatic method of equity weight construction which is both understandable to policy makers and sensitive to the needs of target groups. It could improve the evidence base for resource allocation decisions, and be generalised to other disadvantaged groups who share similar concepts of equity. Development of this decision-making tool represents a potentially important avenue for further health economics research.
Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Language eng
Field of Research 140208 Health Economics
Socio Economic Objective 920204 Evaluation of Health Outcomes
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2009, Ong et al.
Persistent URL http://hdl.handle.net/10536/DRO/DU:30021323

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.