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Health Inequalities: To What Extent are Decision-Makers and Economic Evaluations on the Same Page? An English Case Study

Author

Listed:
  • Sebastian Hinde

    (University of York)

  • Dan Howdon

    (University of Leeds)

  • James Lomas

    (University of York)

  • Matthew Franklin

    (University of Sheffield)

Abstract

Economic evaluations have increasingly sought to understand how funding decisions within care sectors impact health inequalities. However, there is a disconnect between the methods used by researchers (e.g., within universities) and analysts (e.g., within publicly funded commissioning agencies), compared to evidence needs of decision makers in regard to how health inequalities are accounted for and presented. Our objective is to explore how health inequality is defined and quantified in different contexts. We focus on how specific approaches have developed, what similarities and differences have emerged, and consider how disconnects can be bridged. We explore existing methodological research regarding the incorporation of inequality considerations into economic evaluation in order to understand current best practice. In parallel, we explore how localised decision makers incorporate inequality considerations into their commissioning processes. We use the English care setting as a case study, from which we make inference as how local commissioning has evolved internationally. We summarise the recent development of distributional cost-effectiveness analysis in the economic evaluation literature: a method that makes explicit the trade-off between efficiency and equity. In the parallel decision-making setting, while the alleviation of health inequality is regularly the focus of remits, few details have been formalised regarding its definition or quantification. While data development has facilitated the reporting and comparison of metrics of inequality to inform commissioning decisions, these tend to focus on measures of care utilisation and behaviour rather than measures of health. While both researchers and publicly funded commissioning agencies are increasingly putting the identification of health inequalities at the core of their actions, little consideration has been given to ensuring that they are approaching the problem in a consistent way. The extent to which researchers and commissioning agencies can collaborate on best practice has important implications for how successful policy is in addressing health inequalities.

Suggested Citation

  • Sebastian Hinde & Dan Howdon & James Lomas & Matthew Franklin, 2022. "Health Inequalities: To What Extent are Decision-Makers and Economic Evaluations on the Same Page? An English Case Study," Applied Health Economics and Health Policy, Springer, vol. 20(6), pages 793-802, November.
  • Handle: RePEc:spr:aphecp:v:20:y:2022:i:6:d:10.1007_s40258-022-00739-8
    DOI: 10.1007/s40258-022-00739-8
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    References listed on IDEAS

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    1. Sebastian Hinde & Louise Horsfield & Laura Bojke & Gerry Richardson, 2020. "The Relevant Perspective of Economic Evaluations Informing Local Decision Makers: An Exploration in Weight Loss Services," Applied Health Economics and Health Policy, Springer, vol. 18(3), pages 351-356, June.
    2. Frew, Emma & Breheny, Katie, 2020. "Health economics methods for public health resource allocation: a qualitative interview study of decision makers from an English local authority," Health Economics, Policy and Law, Cambridge University Press, vol. 15(1), pages 128-140, January.
    3. Susan Griffin & James Love-Koh & Becky Pennington & Lesley Owen, 2019. "Evaluation of Intervention Impact on Health Inequality for Resource Allocation," Medical Decision Making, , vol. 39(3), pages 171-182, April.
    4. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884.
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    Cited by:

    1. Matthew Franklin & Sebastian Hinde & Rachael Maree Hunter & Gerry Richardson & William Whittaker, 2024. "Is Economic Evaluation and Care Commissioning Focused on Achieving the Same Outcomes? Resource-Allocation Considerations and Challenges Using England as a Case Study," Applied Health Economics and Health Policy, Springer, vol. 22(4), pages 435-445, July.

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