Is health system efficiency improved to the detriment of particularly poor patients?

In the 1960s the United States began implementing policies for improving its healthcare system, policies of a sort that have also come into effect in nearly all industrialized countries in the last decades. For some economists, the primary concern is health system efficiency rather than equal access to medical care: the system must be efficient in order for public services to function correctly. But isn’t this quest for better performance having a social cost today, as it deepens inequalities and/or worsens overall population health?

A recent study shows that health system efficiency and equity have mutually influenced each other over the last twenty years in OECD countries. That relationship, which depends on the type of health system in terms of treatment possibilities, calls into question the postulate that efficiency necessarily precedes equity. 

First of all, being excessively attentive to health system efficiency appears to have a high social cost, which may be defined as exacerbating existing socially-based disparities in health and health care. Efficiency gains may be made to the detriment of equity, especially in health systems that operate mainly in the private sector. 

In contrast, and contrary to orthodox economics, the findings suggest that reducing health inequalities systematically improves health system efficiency in both public and private systems. In other words, a more equitable society in matters of health opens the way to better overall health system performance. 

Source : M.-Q. Bousmah, M. Abu-Zaineh, S. Combes, & B. Ventelou, 2025, “Is the quest for efficiency harmful to health equity? An examination of the health efficiency-equity nexus in OECD countries over the past two decades,” Social Science & Medicine 383