AAs an epidemiologist and physician, I have long been concerned about how health interventions for disadvantaged communities are evaluated. A new study examines that concern and offers solutions to make cost-savings assessments work for everyone.
Many of my patients live in San Francisco’s Bayview neighborhood, which is disproportionately Black, separated from the city by freeways, and plagued by toxic waste from the nearby ships. Neighborhoods often fail to secure the new investments needed to maintain health clinics or develop mixed-income housing or grocery stores because of sound savings reviews that show community investment. he will not bring profit.
For many people who struggle with the difficult decision between paying for medicine or covering essentials such as food, rent and transportation, the results of these tests and the choice of funds they know can have a serious impact on life. they and their comfort.
In a peer-reviewed article recently published in the journal Health Affairs, Atheendar Venkataramani, Dean Schillinger, and we make the case that conventional methods of cost-effectiveness analysis in health economics may continue to not the same in health. This issue deserves the attention of not only academics and researchers but also policy makers, payers, and donors who care about improving health equity.
Cost-effectiveness analyzes are the basis for decision-making. They help determine which initiatives provide the most return per dollar spent. But current methods have a major flaw: they tend to undermine measures that can help disadvantaged groups.
This problem is caused by three main factors:
First, people with disabilities often face higher risks of death from a number of possible causes. This phenomenon, known as competing risks, can make interventions aimed at a specific disease seem cost-effective for these groups even if the intervention is equivalent or more effective for groups at risk. one. If a person does not die from one disease, they are more likely to die from another disease and, according to standard cost-effectiveness analyses, the benefits of preventing the first death are reduced.
Second, because disadvantaged people are often covered by Medicaid (which pays less for doctors and hospitals than Medicare or commercial insurance) or have no insurance at all, they have lower health care costs. This can make interventions designed to prevent costly complications appear to save less money among the disadvantaged than they would for the more fortunate, who often have expensive insurance plans. a lot.
Third, lost productivity is a common factor in cost effectiveness calculations. But because of income inequality, interventions that prevent job losses among disadvantaged groups may appear to have less economic benefit to society because they have less economic impact than among disadvantaged groups. with more opportunities (to put it plainly, in terms of economic numbers, the health and well-being of the poor is there. a little more clearly).
To illustrate why these concepts are problematic, here is a real-life example: examining a program that helps people get nutritious food and participate in physical activity to reduce the risk of diabetes. This intervention may be especially beneficial for Black Americans, who face a higher risk of diabetes. A standard cost-effectiveness analysis based on current national guidelines, however, may determine such an intervention. Small more money for these residents for several reasons. Black Americans face higher risks of dying from other causes such as asthma before developing diabetes and its many complications. They also may not be insured or covered by Medicaid, so preventing complications appears to save a little money. And their low wages mean preventing the loss of productivity seems to be economically useless.
Considering interventions that would benefit the most disadvantaged as too costly (or too cost-effective) to implement not only fails to address existing health disparities but may contribute to their persistence.
To solve this problem, my colleagues and I propose several methods:
First, cost-effectiveness analyzes should not assume that current health disparities will exist forever. This makes it possible to imagine situations where inequality is reduced over time. Second, statistical methods that place higher values of health benefits for disadvantaged groups should be evaluated, recognizing that there is a greater opportunity to use dollars to help those who face more problems than giving the same dollar to those who already have it. many tools. Cost-effectiveness analysts must also broaden their lens. This means accounting for how an intervention can affect many health risks at the same time, rather than focusing on one disease in isolation. For example, environmental pollution in Bayview can contribute to many different diseases from different types of cancer to respiratory disease, not just one condition. Opening the lens also involves including broader societal benefits beyond health care costs and productivity, such as improving educational outcomes or social well-being, in cost-effectiveness analyses.
Cost performance analysis professionals need to have an open discussion about the implications of current practices for this work. Creating disparities in assessment risks perpetuating a system that has historically undermined the lives of disadvantaged communities. This goes against the principles of health equity and social justice that many in the medical and public health professions hold dear.
Health researchers and policy makers have a responsibility to ensure that their assessment tools promote equity rather than hinder it. Advanced and fine-tuning methods can help ensure that cost-effectiveness analyzes become a force for reducing health disparities, not reinforcing them.
This will not be an easy task. It requires rethinking long-held assumptions about economics, challenging established and powerful scholars who have made it their business to publish studies using existing methods, and asking honest questions about the nature of studies. and methods that often exclude those most affected. about them. But it is a necessary step if we are to create an equitable health system.
Finally, this isn’t just about improving testing methods. It is about recognizing the full value of every life and every community. Doing so can lead to better decisions that serve all members of society, especially those that have historically been overlooked. It is time for research methods to achieve the goals of health equity.
Sanjay Basu, MD, Ph.D., is a primary care provider, epidemiologist, and chief medical officer of Waymark, a public benefit company dedicated to improving the experience and quality of care for people with get Medicaid benefits. She provides primary care, substance abuse, HIV, and hepatitis treatment to patients at San Francisco’s HealthRight360 Integrated Care Center for food-neutral adults.
#Costeffectiveness #health #interventions #perpetuate #health #disparities #Heres #fix