London School of Hygiene & Tropical Medicine

Reducing inequalities in what?  A diagrammatic exposition inspired by the recent Norwegian debate on priority setting guidelines

Prof Jan Abel Olsen, Institute of Community Medicine, University of Tromsø, Norway & Centre for Health Economics, Monash University, Australia

Speaker: Jan Abel Olsen is a professor of health economics and research director in the Department of Community Medicine, University of Tromsø, Norway, and an adjunct professor in the Centre for Health Economics, Monash University, Australia.

His research areas include: Measurement and valuation of health outcomes; Efficiency vs equality; Primary care financing; Socio-economic determinants of health; Global health. Jan has published extensively in the leading health economics journals. An interest in the wider subject area is signified by his monograph Principles in Health Economics and Policy, OUP, 2009, which is currently undergoing a major revision. Jan was a member of the Government appointed commission recommending new priority setting guidelines in Norway.

Summary: Policy objectives in most publicly funded healthcare systems relate to efficiency as health maximization, and equity in the distribution of health gains. The more a health care programme contributes to the reduction in inequality, the higher its priority. But, which type of health inequalities are to be reduced, i.e. equality of what? Different countries have been influenced by different equity criteria. This paper will outline four criteria: i) prognosis (e.g. the ‘end-of-life’ argument in the UK); ii) relative shortfall (proposed in the Netherlands); iii) absolute shortfall, and; iv) lifetime health losses. The last two criteria have recently been on the health policy agenda in Norway. They differ as to whether past health losses are considered priority relevant. An analytical framework is presented to compare and illustrate the key differences across the four criteria.