Fairness and equity stand as cornerstone principles in
public policy, wielding significant influence in public, political, and legal
spheres. In the realm of universal health coverage (UHC), these values play a
pivotal role, shaping both the motivation for UHC and the choices made on the
path to its attainment. As Egypt strives towards UHC, it must grapple with the
imperative of making progress fairly and equitably, particularly in expanding
priority services, including more people, and reducing out-of-pocket payments.
Fairness and equity fundamentally revolve around the
distribution of benefits and burdens in society. While the precise definitions
of these concepts may vary, they are often used interchangeably. Within this
framework, two key dimensions emerge: horizontal equity, which demands equal
treatment of relevantly similar cases, and vertical equity, which necessitates
appropriately unequal treatment of dissimilar cases. These standards guide the
distribution of health benefits, service coverage, and financial contributions
to the health system.
In the pursuit of UHC, countries must balance the
objectives of fairness and benefit maximization.
While fairness concerns the distribution of benefits across
individuals, benefit maximization focuses on maximizing the total sum of
benefits for society. Often, policies that are deemed most fair also yield the
greatest sum of benefits. However, there are instances where the fairest policy
may not align with the one maximizing benefits, requiring careful consideration
and balancing of objectives.
Three guiding considerations emerge for choices on the path
to UHC:
1. Fair distribution: Coverage and use of services
should be based on need, with priority given to policies benefiting the
worse-off groups.
2. Cost-effectiveness: Priority should be accorded to
the most cost-effective policies, ensuring the optimal allocation of resources
to generate maximum health benefits.
3. Fair
contribution: Contributions to the health system should be based on ability
to pay rather than need, promoting the separation of service use from payment.
These guiding considerations offer direction for addressing
critical issues of distribution on the path to UHC. However, they must be
balanced against each other and other relevant concerns, emphasizing the need
for nuanced decision-making and policy implementation.
In navigating Egypt's journey towards UHC, a steadfast
commitment to fairness and equity is essential. By aligning policies with these
principles and carefully weighing competing objectives, Egypt can chart a
course towards a more inclusive and equitable healthcare system, ensuring that
all citizens have access to essential health services without facing undue
financial hardship.
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