Longwoods Blog

Health Equity Dialogues   

The Equity MAgIC  group is a collective of stakeholders actively working on pushing the equity agenda forward. The goal is to ensure equity is consistently part of the decision process across the spectrum of planning, strategy, review and measurement in health care. From its starting point as a CIHR-funded research grant to develop an equity measurement tool, the process of disseminating the outcomes of the research has led to a series of dialogues among diverse individuals to share how they address the inequities challenges. We invited some of those individuals to share their perspective on the impact, importance and implementation of measurement.

The goal of this series is to generate awareness and further dialogue to continue the process of embedding equity in key system and organizational drivers such as quality improvement and performance management.

Equitable access to care

Equitable access to care.  Simply put – access to care that matches the individual’s need for care – remains a touchstone of our healthcare system and one of the concrete ways that we define ourselves as a society. Yet, studies such as The Power Study Reports by Arlene Bierman and colleagues continue to show that substantial inequities remain in our system. These reports compare access and outcomes by sex and other socio-economic factors to provide one of the most comprehensive studies of differences in access to care and the consequences of these differences. So, the question remains, what can be done?

Canada has long led the world in thinking about inequities and the broader determinants of health. The Lalonde and Epp reports and the work of the Canadian Institute for Advanced Research are just three prominent examples of this. But we have done little to correct the inequities in healthcare and health. While other countries have worked to make progress on inequity, we’re still asking “what can we do to accelerate change in Canada?”

Public reporting of results is a powerful tool for motivating change, establishing accountabilities and creating transparency. If done correctly, public reporting can draw the attention of clinicians and policy-makers to areas of deficiencies and motivate positive change. And we have used public reporting in Canada – as in our wait time efforts – to help drive improvements.

Over the past several years we have worked, with funding from the Canadian Institutes for Health Research, to create measures of equitable access suitable for public reporting. These measures can be compared across provinces and regions and across types of hospitalization. Our focus was gender equity, but our methods – built around decision tree analysis,the gini coefficient and the linkage of survey and hospital data – can be used to look at equity from a number of perspectives.

Our results are straight forward and sadly unsurprising. Ambulatory care sensitive admissions that may have been avoided with better access to care were more inequitable for women than for men. For both men and women factors like lower educational attainment or lower income led to higher rates of these hospitalizations, but their impact was greater on women than for men. When we looked at whether or not women and men were able to access angiograpy after heart attack, the same picture emerged with a greater impact on women. There were also surprising differences across regions in Canada with greater inequity in Ontario compared to the West. Interestingly, these differences between men and women disappeared when looking at whether or not they were able to get surgery quickly after hip fracture. This positive result may be due to the clarity surrounding hip fracture. People go to hospital after hip fracture, the diagnosis and treatment is clear, and thankfully in our system, the care is free at the point of consumption. Similar conclusions were drawn when comparing the expediency of angiography procedures following an acute coronary syndrome, suggesting access but not timeliness to care contribute to inequitable health care between men and women.

We have inequity in our system. Now, we can measure, compare, and even benchmark equity. When will we treat equity like wait times, and measure it, report it, and put resources behind it?  When we do, we may see important progress on the health of our populations and in the fairness of our system.

About the Author:

Adalsteinn (Steini) D. Brown
Adalsteinn Brown became the Dalla Lana Chair of Public Health Policy at the University of Toronto and a Scientist in the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital on the first of January, 2011.  Past roles span the public, private, and government sectors and include Assistant Deputy Minister for strategy at the Ontario Ministry of Health and Long-term Care and for science and research at the Ontario Ministry of Research and Innovation, Assistant Professor in the Department of Health Policy, Management, and Evaluation (University of Toronto), and a founding role in consulting, software, and internet companies.

He received his bachelor’s degree in government from Harvard University and his doctorate from the University of Oxford, where he was a Rhodes Scholar. In 2003, he was named one of Canada’s “Top 40 Under 40″ in recognition for his work on performance measurement in health care.

About Equity MAgIC
MAgIC (Measuring and Managing Access gaps In Care) is a performance measurement system for measuring equity in access to health care. It was developed under a grant funded by the Canadian Institutes of Health Research, Institute of Gender and Health with the support of University of Toronto, Faculty of Medicine and is administered in collaboration with The Wellesley Institute. The performance measurement system is comprised of a two-step approach that uses decision tree analysis to segment populations and uses the difference in rates of outcomes to generate a measurement of the inequity gap for policy and decision making now, and measurement over time.  www.equitymagic.ca

This entry was posted on Friday, March 2nd, 2012 at 2:22 am and is filed under Longwoods Online.