Equity relates to the extent to which outcomes, access to outputs and payments for them are distributed fairly across individuals, regions or parts of a society. Most long-term care and healthcare systems are inequitable in that their benefits are not distributed in ways that might widely be seen as fair, due to the influence of social, economic, political or underlying demographic factors. Access to services (and, hence, access to the potential impacts of those services in terms of better outcomes) may be unfairly distributed by gender, ethnicity, age, language, religion, income, socioeconomic group or place of residence.

An examination of equity requires that a definition must be specified for ‘fairness’. Equity is generally not the same as equality in the provision of services, as people do not have identical needs, so that an equitable allocation of resources would be likely to require giving more resources to people with greater needs. Similarly, it might be seen to be more equitable to ensure that individuals with the lowest ability to pay for care are asked to pay lower amounts than those with greater ability to pay (i.e. with greater wealth or higher incomes). The most commonly discussed aspects of equity are (a) whether incidence and prevalence of need are linked to socioeconomic status, ethnicity or other personal characteristics; (b) whether access to (evidence-based) interventions is linked to type and level of need, as well as to these personal characteristics; and (c) whether individual financial contributions are linked to ability to pay.

How then is the concept of ‘fairness’ chosen? Equity could be defined or operationalized by reference to various political philosophies. For example, conventional welfare economics is often associated with utilitarian philosophy, seeking that distribution of resources that will maximize total welfare (wellbeing) (Barr 2014). Rawls (1972) is one of a number of philosophers to have criticised utilitarianism; he suggested the maximin principle that policies should be designed (and hence social investments planned) so as maximize the wellbeing of the least well-off members of society. Collectivist philosophies emphasise equality, and libertarians emphasise autonomy and freedom of choice when make judgements about equity.