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Open Access Debate

On decreasing inequality in health care in a cost-effective way

Antti Malmivaara

Author Affiliations

Centre for Health and Social Economics, National Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland

BMC Health Services Research 2014, 14:79  doi:10.1186/1472-6963-14-79

Published: 20 February 2014



Scientific evidence indicates that access to health care services shown effective is often poorer among the disadvantaged people than among the non-disadvantaged. Advancing cost-effectiveness and equality in obtaining services shown effective are often stated as the two main objectives for health care.


The important question is how to decrease inequality in a most cost-effective way. Some evidence indicates that effectiveness and cost-effectiveness of interventions may be high among the disadvantaged patient groups. However, the relationship between decreasing inequality and cost-effectiveness is complex and depend e.g. on clinical and health care system factors.


To expand the knowledge base for advancing equality in a cost-effective way, scientific efforts on four levels are suggested: research into ways how practitioners can provide efficient services for the disadvantaged patients, widening of scope at all levels of evidence based medicine to account also for the disadvantaged, research on quality improvement and evidence implementation, as well as benchmarking research including documentation of services among the disadvantaged.

Benchmarking; Cost-effectiveness; Evidence based medicine; Inequality; Medical ethics; Quality improvement; Real effectiveness medicine; Socioeconomic status