Paolo Belli, Research Fellow, Department of Population and International Health Harvard School of Public Health - August 2001, Professor at Pavia University, Pavia Italy, and Lecturer at Bocconi University. This paper introduces a conceptual framework to investigate into the equity consequences of resource allocation, strategic purchasing and payment system reforms in health. It also presents a selective survey of the evidence available on the distribution of health, on utilization of public health services across socio-economic groups, and on the equity impact of RAP reforms in a number of developing countries. In the first part, the paper tries to define what are the core elements that characterize RAP reforms, and what we mean by an equitable or more equitable allocation of health resources. The paper traces the origins of the RAP (resource allocation and purchasing) reforms and it highlights their key components, including: New resource prioritization policies (that in several developing countries have been identified with the introduction of the package of essential services); A change in the resource allocation criteria; The interposition of a purchasing agency between patients and providers; A change in the payment system criteria for providers; New financial and other incentives/enablers to reach the poor/cure diseases that primarily affect the poor. Different countries have pursued distinct priorities through RAP reforms and they have implemented distinct combinations of the above five reform. The aims pursued through RAP reforms have included: efficiency, reduction of total health costs, public services? quality and consumer responsiveness, cost-effectiveness, accessibility, and ability to reach the poor. The paper looks at equity, to clarify what is the meaning of an equitable allocation of health, or health care provision, or an equitable repartition of the health-funding burden. In order to address such questions, rather than just limiting to health and presenting some of the measures that are generally used in the literature on equity in health, the authors chose to reconsider the notion of equity by addressing four basic questions: 1. According to which criteria can we assess that a certain distribution of resources is equitable? Are health and health care to be considered as a human right, or as a normal commodity, or else? 2. Equality of what? 3. Are governments capable of redistributing resources (including health care)? What are the limits to the extent of redistribution? 4. According to which equity criteria should redistribution of health resources take place?