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LATIN AMERICAN SOCIAL MEDICINE: Asa Cristina Laurell What Does Latin American Social Medicine Do When It Governs? The Case of the Mexico City Government Am J Public Health 2003; 93: 2028-2031 [Abstract] [Full text] [PDF]

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What about the equity-efficiency trade-off?

Ramon Castano   (17 February 2004)

What about the equity-efficiency trade-off? 17 February 2004
Ramon Castano Send letter to journal: Re: What about the equity-efficiency trade-off? rcastano{at}post.harvard.edu Ramon Castano	Interesting experience, but the paper gives the impression that the Mexico City Government does not face a budget constraint. Even with the 67% increase in budget the author mentions, it seems implausible that the government can afford to ingnore budget constraints and efficiency issues. Universal access with free-at-point-of-delivery health care services holds an unfulfilled promise in developing countries for more than three decades after the intent of Alma-Ata’s health for all. Thus, it makes sense to better target subsidies to improve the poorest’s health status and bridge the equity gap. Of course, this is an efficiency-biased decision rule. However, a reasonable balance between efficiency and the concept of equity used by the author (equal acces to services, given the same need) involves an inescapable trade-off that she does not seem to acknowledge, in spite of a laconic mention to the issue of efficiency.