The NHS is facing a dilemma between the goals of equity and efficiency. An editorial in this week's BMJ reports that there is no consensus on how to deal with policies that may cause conflict, often leading to inconsistent judgements in the development of health policies.
The authors cite several examples of inconsistency among current NHS policies. For instance, using economic incentives to general practitioners to maximise coverage of cervical cancer screening fails to address the issue of low participation by many women at high risk (particularly those in disadvantaged socioeconomic groups).
Likewise, the policy indicating when universal, rather than selective, screening for sickle cell disease in newborn babies should be used may reflect an aspiration to equal access for equal need, but at a very high cost. More examples of inconsistency can be found among current NHS policies, say the authors. But is it realistic to expect health policymakers to address the equity versus efficiency dilemma? Recent evidence, showing a complete neglect of the equity dimension in studies of healthcare economic evaluations, suggests that both researchers and policy makers share responsibility for the inconsistent pursuit of equity in the NHS, they conclude.