Equity, quality, and gatekeeping

The Declaration of Alma-Ata in 1978 aimed to reduce health inequalities and proposed health for all by year 2000. In health care, inequalities are the differences in health status or in the distribution of health determinants between different groups in the community. Social, economic, political, demographic, and geographic perspectives will be discussed to address health-care inequality. This chapter illustrates the philosophy of equity in primary care with reference to the quality of care and gatekeeping practices. Equity is the absence of avoidable or remediable differences among groups of people. Health inequities involve more than inequality with respect to health determinants, access to the resources needed to improve and maintain health. It is more about fairness and human rights norms to enjoy life and pursue individual life plans. This chapter further elaborates on how the principles are translated to practice in the provision of quality primary health care in the community setting. The likelihood of desired health outcomes is increased by the services which are consistent with current professional knowledge and standards. Moreover, patient satisfaction and effectiveness of treatments are enhanced by quality management in primary care. The gatekeeping function will be described based on the patient-focus approach, which is the key to successful primary health care in meeting the needs and expectations of the community.