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Health equity monitoring for healthcare quality assurance

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  • Cookson, R.
  • Asaria, M.
  • Ali, S.
  • Shaw, R.
  • Doran, T.
  • Goldblatt, P.

Abstract

Population-wide health equity monitoring remains isolated from mainstream healthcare quality assurance. As a result, healthcare organizations remain ill-informed about the health equity impacts of their decisions – despite becoming increasingly well-informed about quality of care for the average patient. We present a new and improved analytical approach to integrating health equity into mainstream healthcare quality assurance, illustrate how this approach has been applied in the English National Health Service, and discuss how it could be applied in other countries. We illustrate the approach using a key quality indicator that is widely used to assess how well healthcare is co-ordinated between primary, community and acute settings: emergency inpatient hospital admissions for ambulatory care sensitive chronic conditions (“potentially avoidable emergency admissions”, for short). Whole-population data for 2015 on potentially avoidable emergency admissions in England were linked with neighborhood deprivation indices. Inequality within the populations served by 209 clinical commissioning groups (CCGs: care purchasing organizations with mean population 272,000) was compared against two benchmarks – national inequality and inequality within ten similar populations – using neighborhood-level models to simulate the gap in indirectly standardized admissions between most and least deprived neighborhoods. The modelled inequality gap for England was 927 potentially avoidable emergency admissions per 100,000 people, implying 263,894 excess hospitalizations associated with inequality. Against this national benchmark, 17% of CCGs had significantly worse-than-benchmark equity, and 23% significantly better. The corresponding figures were 11% and 12% respectively against the similar populations benchmark. Deprivation-related inequality in potentially avoidable emergency admissions varies substantially between English CCGs serving similar populations, beyond expected statistical variation. Administrative data on inequality in healthcare quality within similar populations served by different healthcare organizations can provide useful information for healthcare quality assurance.

Suggested Citation

  • Cookson, R. & Asaria, M. & Ali, S. & Shaw, R. & Doran, T. & Goldblatt, P., 2018. "Health equity monitoring for healthcare quality assurance," Social Science & Medicine, Elsevier, vol. 198(C), pages 148-156.
    • Handle: RePEc:eee:socmed:v:198:y:2018:i:c:p:148-156
    DOI: 10.1016/j.socscimed.2018.01.004
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    1. Asaria, Miqdad & Doran, Tim & Cookson, Richard, 2016. "The costs of inequality: whole-population modelling study of lifetime inpatient hospital costs in the English National Health Service by level of neighbourhood deprivation," LSE Research Online Documents on Economics 101244, London School of Economics and Political Science, LSE Library.
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    Cited by:

    1. Mohammad Habibullah Pulok & Kees Gool & Mohammad Hajizadeh & Sara Allin & Jane Hall, 2020. "Measuring horizontal inequity in healthcare utilisation: a review of methodological developments and debates," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(2), pages 171-180, March.

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