Distributional cost-effectiveness analysis (DCEA) is a framework for incorporating health inequality concerns into the economic evaluation of health sector interventions. In this tutorial we describe the technical details of how to conduct DCEA, using an illustrative example comparing...

The current debate about reforming the NHS is surprising in a number of ways. Timmins (1988) points out that it was unforeseen and not part of the Government’s main concerns after winning the election in June 1987. It is surprising in another way because it is only six years ago since there...

Most people agree that equity has something to do with equality – but equality of what? This paper discusses five relevant “respects” according to which horizontal or vertical equity for individuals or groups of people might be achieved: marginal willingness to pay, per capita expenditure,...

This paper presents evidence on the extent to which the finance and the delivery of health care in Britain are equitable. The analysis of health care delivery focuses on whether there is ‘equal treatment for equal need’ irrespective of income. Examination of data from the 1985 General...

The question of what rules should be used in determining access to health and health care has been hardly addressed in the public debate on the future of the health service. In the UK, as in other countries, the goal of efficiency (production of output using least cost-methods) has dominated...

Four distributional principles for the allocation of health care resources are discussed: equal expenditures per capita, proportionality to need, proportionality to endowment health status, and proportionality to capacity to benefit. They are compared with another process, concept of equity,...