At a Convention of the Medical Committee for Human Rights held in Chicago in March 1966, Martin Luther King Jr declared: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane”,¹ and in the Institute of Medicine report “Crossing the Quality Chasm: A New Health System for the 21st Century”² published in 2001 it is stated that a healthcare system should provide “care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status”.

In the 21st century there are still countries where health systems put a price on care that the patient must pay at the point of service. For example, in the United States, where over 45 million citizens are without healthcare insurance, many must purchase care with personal resources. As a consequence, health care competes with the other necessities of life like food and clothing. Such health systems can be characterized by variation in healthcare outcomes that is related to …