State of the Art in Research on Equity in Health

Abstract

This essay provided the introduction to a workshop in Bellagio, Italy, on the subject of translating research into policy for equity in health. The essay first defines equity in a way that facilitates its assessment and monitoring and then summarizes evidence from existing research. Directions for developing policy strategies follow from these principles. The role of health services in influencing the distribution of health in populations is discussed in the special context of primary-care-oriented health systems that are, at the same time, more effective, more efficient, and more equity producing than is the case for specialist-dominated health systems.

Measuring Comprehensiveness of Primary Care: Challenges and Opportunities

“…Greater efficiency, defined as a wider range of services, with better health outcomes, provided at lower costs, [5][6][7][8][9][10] lower hospitalization rates for ambulatory care-sensitive conditions, 8,11 improved health and better selfreported health outcomes, 6,8,9,11,12 and greater equity (i.e., reduced disparities in disease severity as a result of earlier detection and prevention across different populations), [5][6][7][8][9][10] are all linked to more comprehensive primary care. Without comprehensive primary care, patients experience fragmented care across numerous different specialists, resulting in higher healthcare costs, more diagnostic tests and interventions, and more types of medications.…”

“…specialty care, hospital care). [1][2][3][4][5] Comprehensiveness is associated with numerous benefits, 1,[5][6][7][8][9][10][11][12] yet several studies suggest it is declining in the U.S. and Canada . [13][14][15][16][17] Here, we discuss the rationale for measuring comprehensiveness in primary care, enumerate the challenges, including available data sources, then describe approaches to measuring comprehensiveness and suggest areas for future research.…”

Disentangling the Linkage of Primary Care Features to Patient Outcomes: A Review of Current Literature, Data Sources, and Measurement Needs

“…[61][62][63][64][65][66][67][68] Interpersonal continuity is highly valued by both patients and providers, and it has been associated with better adherence to provider recommendations. [69][70][71] Comprehensive primary care, which involves meeting the large majority of each patient's physical and mental health care needs, has been associated with better health outcomes provided at lower cost, 11,14,17,23,72,73 lower hospitalization rates for ambulatory care-sensitive conditions, 14,74 improved health and better self-reported health outcomes, 11,14,17,72,75 and greater equity (i.e., reduced disparities in disease severity as a result of earlier detection and prevention across different populations). 11,14,17,23 Better coordination between primary care and specialists (reflected by better communication and information exchange, use of nurses to help coordinate patient care between providers, or primary care coordination of referrals to specialists) has been associated with less service duplication, better patient outcomes, [76][77][78] greater satisfaction for providers and patients, 78,79 and higher overall efficiency.…”

Equity of colorectal cancer screening: which groups have inequitable participation and what can we do about it?

“…For the purposes of this paper, a key distinction needs to be made between a relatively large field of research which defines equity in health (Braveman, 2006;Sen, 2006;Starfield, 2006) and an emerging field of research which defines equity in healthcare (Oliver & Mossialos, 2004;P. Ward, 2009a, b).…”