Marten J. Poley - Erasmus Universiteit Rotterdam

118Chapter 7entirely justified, for, as was shown above, many equity theories precisely requirethat priority be given to the young and to the most life-threatening diseases.This is not the answer to all questions, however. One significant problem remainsthat each of these theories loses its force at some point. For example, it would besenseless to assign all health care interventions a priority ranking according topatients' age, and direct more and more money to those assigned the highestpriority (e.g., severely ill young children), no matter its effectiveness or costs.This shows that equity principles should be given effect while taking into accountcost-effectiveness arguments. Just as decision makers are expected to weighefficiency and equity objectives, the different possible equity approaches shouldbe wisely balanced against each other (in a so-called equity-equity tradeoff). Howexactly to consider equity in prioritizing health care programs for resourceallocation is an issue around which there is at present times not yet anymethodological consensus. One point of this discussion however, is fairly clear:we must be willing to sacrifice some overall efficiency for a more equitabledistribution of health. Incorporating equity arguments would probably betterexplain policy decisions in areas where cost-effectiveness analyses have beenpublished. 86 Apparently, decision makers and the public place greater emphasison equity than is reflected by cost-effectiveness analysis. Importantly, surveyfindings indicate that politicians are indeed prepared to accept a lower growth inper capita health in exchange for increased equity. 45,87Finally, continued efforts are called for to retain the good cost-effectiveness ofneonatal surgery and to properly assess cost-effectiveness in the future, withattention to new and advancing research themes such as the position of theparents and discounting. For the moment, it is safe to conclude that neonatalsurgery—although met with skepticism by people questioning the high costs oftreatment and the possibility of poor HRQoL in the survivors—yields good valuefor money. It also contributes to an equitable distribution of health and healthcare.ACKNOWLEDGMENTSThe authors gratefully acknowledge J. Hagoort for editing the manuscript.