Challenges, solutions and future directions in the evaluation of service innovations in health care and public health
Rosalind Raine, Ray Fitzpatrick, Helen Barratt, Gywn Bevan, Nick Black, Ruth Boaden, Peter Bower, Marion Campbell, Jean-Louis Denis, Kelly Devers, Mary Dixon-Woods, Lesley Fallowfield, Julien Forder, Robbie Foy, Nick Freemantle, Naomi J Fulop, Elizabeth Gibbons, Clare Gillies, Lucy Goulding, Richard Grieve, Jeremy Grimshaw, Emma Howarth, Richard J Lilford, Ruth McDonald, Graham Moore, Laurence Moore, Robin Newhouse, Alicia O’Cathain, Zeynep Or, Chrysanthi Papoutsi, Stephanie Prady, Jo Rycroft-Malone, Jasjeet Sekhon, Simon Turner, Samuel I Watson and Merrick Zwarenstein
Essay 5 Evaluating health-care equity Raine R, Or Z, Prady S, Bevan G
Abstract: The evaluation of health-care equity necessitates measuring both horizontal and vertical equity components to establish whether or not patients receive the health care across levels of need. Examining interactions between social factors of concern and need, or stratifying analyses according to different levels of need, can be used to identify horizontal and vertical equity. Increased data linkage across sectors and settings is vital for identification of sources of inequity and, crucially, to ascertain whether or not any identified variation has clinical relevance. Macro-, meso- and micro-level determinants of equity should always, ideally, be considered. However, examination of the ‘gap’ or the ‘gradient’ will depend on the intervention studied. Emerging techniques should be harnessed, for example machine learning to more completely exploit data sources on need, case mix and outcomes; and interactive multimedia techniques to examine social variations in clinical decision-making.
This essay should be referenced as follows: Raine R, Or Z, Prady S, Bevan G. Evaluating health-care equity. In Raine R, Fitzpatrick R, Barratt H, Bevan G, Black N, Boaden R, et al. Challenges, solutions and future directions in the evaluation of service innovations in health care and public health. Health Serv Deliv Res 2016;4(16). pp. 69–84.