People with the most means – whose needs for health care are often less – consume the most care, whereas those with the least means and greatest health problems consume the least. Public spending on health services most often benefits the rich more than the poor in high- and low-income countries alike.
How to do the balancing act?
Syed - it's an age-old dilemma; the same as 'those that have wealth continue to get more and those that continue to have less wealth lose more'. There is no 'magic bullet' nor an overnight solution. The only way to counter the issue is a strong political will based around more equitable distribution of resources and equal access for all to those resources. Those countries that have the best health-care systems and 'happier people' are those where the gap between rich and poor is less visible and 'class systems' are less evident. Many of the Scandanavian countries, for instance, serve as good role models. However, even then, there will always exist an element of 'inverse care'. Anything else is what might be referred to as Utopia, Xanadu etc - and they are 'mostly made up of dreams'
The easiest, but most often wrong answer, is targeting, which requires "more tests of the poor" and all. Rather the simple principle voiced by our colleague Julian Tudor Hart: "If everybody is insured, nobody needs insurance." The just distribution of health services, "according to need and not according to wealth", may not be fully achieved by universal coverage/ Juilan Tudor Harts's principle, but it helps. As in the Nordic countries, - see if I can make a link to a Lancet Comment.
And it probably helps for health professionals to be aware of the inherent forces in "Inverse care law", still a Julian Tudor Hart-coined phrase.
As a GP and a researcer, my concern over some years has been to avoid the the effects of the Inverse care law in primary care. Actually, it doesn'l look so bad in Norway, - use of GP services seem to be distributed roughly accpording to need.
Article Welfare for all--or only for the needy?
... we addressed this question in the large population based HUNT study recently
Article Socio-economic inequalities in Norwegian health care utiliza...
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