Improving Health Care System Efficiency for Equity, Quality and Access: Does the Healthcare Decision Making Involve the Concerns of Equity? Explanatory Review

Background: Healthcare is a complex investment which requires a number of stakeholders to produce desired health outcomes. In addition to its complex nature, availability of limited resources for providing healthcare for population poses a number of questions for policy makers. Among these multitudes of questions, Efficiency, Equity and Effectiveness have complex interplay and require balanced tradeoff. Therefore, this explanatory review was conducted with intention to provide basic information on how to incorporate efficiency, equity and effectiveness in healthcare decision making. Method: We systematically searched PubMed/Medline, Scopus, and Google scholar with the following with the following queries: Effectiveness, Efficiency, Equity, Delivery of healthcare, Health care decision making. Results: Inefficiency in health systems is a global problem. About 20-40% global health expenditure is considered as w stage. Efficiency, Effectiveness and Equity are synergistic pillars of quality healthcare system. Improving efficiency in health system can reduce raising healthcare expenditure. Providing equitable care for all has national and international importance. Priority setting, multiple criteria decision making and incorporation of equity impact and trade-off analysis on costeffectiveness can be used for balancing tradeoff between efficiency, equity and effectiveness. Conclusion: Efficiency of healthcare system is important for improving, equity, effectiveness and access to healthcare. Taking efficiency into healthcare delivery with full understanding of determinants of disease in specific population can provide room for improving effectiveness and equity in healthcare as evidenced by presence of avoidable wastages and inefficiency in every healthcare system. Equity should be considered during planning process along with economic evaluations.