Guest Blog: A Research Agenda to Ensure High Value and Equitable Health Care
While a wealth of research on health care value and equity exists, the combined concept of high value, equitable care is relatively new and understudied. To bring an equity lens into the arena of health care value, AcademyHealth, with funding from The Donaghue Foundation, launched an initiative in October 2021 to outline a research agenda on high-value, equitable care.
The Importance of Studying High-Value, Equitable Care
Research dedicated to improving health care value and equity is important for several reasons:
- Addressing Persistent Disparities: Despite advancements in medicine and public health, disparities in health care access, quality, and outcomes persist across racial, ethnic, socioeconomic, and geographic lines. These inequities undermine public trust in the health care system and exacerbate poor health outcomes.
- Improving Systemic Efficiency and Value: High-value health care emphasizes delivering the most effective care to improve health, while avoiding unnecessary tests and treatments.
- Enhancing Long-Term Health Outcomes: Research consistently shows that equitable health care systems lead to better long-term health outcomes for both individual patients and the larger population. By prioritizing equity alongside value, we can foster practices that reduce the burden of disease and improve overall well-being.
- Guiding Policy and Practice: Without a robust research foundation, efforts to integrate both equity and value into health care can be fragmented or ineffective. A strong evidence base is needed to inform policy, guide health care delivery, and set benchmarks for measuring progress.
- Fostering Public Trust and Accountability: A health care system that prioritizes both equity and value demonstrates a commitment to fairness, transparency, and accountability—qualities that are critical for maintaining public trust.
Defining and Driving High-Value, Equitable Care
We worked with a consensus group of 20 stakeholders representing a diverse range of expertise and experience to define high-value, equitable care as existing when diverse individuals’ needs and preferences for health care are met in ways that:
- are timely and easily accessible to all and support equal opportunities for health;
- are respectful, collaborative, culturally responsive, and provided without bias or discrimination;
- increase the likelihood of achieving optimal health outcomes for all;
- are affordable for all individuals and society; and
- are supported by evidence.
In collaboration with the consensus group, we further outlined key drivers necessary for attaining high-value, equitable care, which were used to guide development of the research agenda:
- A Fair and Just Culture of Whole-Person Health for All
- Care That is Accessible to All Patients
- Health System Centered Around Primary Care
- Adequate Health System Capacity to Deliver Care
- Health System Accountability for Outcomes
The final research agenda consists of 30 research questions for proposed study across the five drivers, and a sixth domain for improving research infrastructure.
A Snapshot of Research Questions for Improving Health Care Value and Equity
Taken from the full set of research questions that were generated, we highlighted some key areas of research that we think will be particularly important for better understanding, informing, and improving health care value and equity:
- How can research be designed to effectively capture the nuanced ways in which people are truly encountering and perceiving discrimination?
- What is a comprehensive methodology to assess the social and economic implications for patients and families, when receiving and foregoing care, that considers factors such as total cost, time away from work, transportation, and caregiving responsibilities?
- How do we ensure retention of the primary care workforce and increase the number of primary care providers available to underserved populations?
- How can research, academic, and funding infrastructure be re-designed to create accountability for equitable engagement of patient and community involvement in research?
Taking Up the Agenda
The research agenda on high-value, equitable care sets the stage to explore how economic and social value can be intertwined. Addressing these issues is essential for a health care system that effectively balances value, equity, and long-term sustainability. We urge funders, policymakers, and researchers to take up these critical areas of inquiry to improve health care value and equity through action-oriented and community-engaged research. If you have feedback on our agenda or this work, please contact us at [email protected].