A Theory-Based Framework to Incorporate Health Equity in Economic Assessments

OBJECTIVES: Including an equity lens in economic analysis will allow for data-driven decision making on strategies and policies to address health disparities. The impact of social determinants of health (SDoH) on mortality and morbidity occur through complex interplay and intermediatory processes. Although many health equity frameworks are available, existing models do not offer a comprehensive approach to operationalize the data collection required to conduct health equity and economics research.

METHODS: Based on the gaps identified in prior models, we decided to incorporate two separate but interlinked components. The first component presents the four-step pathway with determinants (political and policy context), SDoH categories, SDoH-Driven barriers and health outcomes. The second component of the model presents the mechanism by which SdoH-driven barriers impact health outcomes. SDoH barriers can result in health-care related failures such as low levels of screening or delay in initiating care. These failures can occur across the entire care continuum from preventive services to end-of-life care and result in health disparities through disease incidence, late-stage diagnosis, increased morbidity and higher mortality. They can also result in economic burden through higher copayments and loss of income due to morbidity or premature mortality. The initial version of the model was reviewed by 12 health equity researchers and feedback was used to ensure that a comprehensive set of SDoH data measures were incorporated.

RESULTS: We tested the robustness of the framework by successfully conducting two economics assessments. First, the model provided a roadmap for a survey to identify barriers along the cancer care continuum and the financial burden posed by these barriers. Second, the model informed a microsimulation study on disparities in colorectal cancer screening, diagnosis and mortality to derive optimal policies to improve health equity.

CONCLUSIONS: Economics assessment should utilize appropriate theory-based frameworks to generate data-informed policies and strategies to address health disparities.