Abstract
Chronic diseases are highly important for the future level and distribution of health and well-being in western societies. Consequently, it seems pertinent to assess not only efficiency of chronic care but also its impact on health equity. However, operationalisation of health equity has proven a challenging task. Challenges include identifying a relevant and measurable evaluative space. Various schools of thought in health economics have identified different outcomes of interest for equity assessment, with capabilities as a proposed alternative to more conventional economic conceptualisations. The aim of this paper is to contribute to the conceptualisation of health equity evaluation in the context of chronic disease management. We do this by firstly introducing an equity enquiry framework incorporating the capabilities approach. Secondly, we demonstrate the application and relevance of this framework through a content analysis of equity-related principles and aims in national chronic disease management guidelines and the national diabetes action plan in Denmark. Finally, we discuss how conceptualisations of equity focused on capabilities may be used in evaluation by scoping relevant operationalisations. A promising way forward in the context of chronic care evaluation may emerge from a combination of concepts of capabilities developed in economics, health sciences and psychology.
Highlights
Chronic diseases are highly important for the future level and distribution of health and well-being in western societies
It has been argued that the main contribution of economics to decision making in health care happens through the concepts of efficiency and equity as criteria to judge the use of scarce health care resources – but “there is far less agreement within economics about equity than about efficiency” (Morris et al, 2007: 18)
We suggest that applying theoretical conceptualisation to a specific health issue and the associated care policies may help bridge the gap between theoretical deliberations and practical applications in health equity studies
Summary
Chronic diseases are highly important for the future level and distribution of health and well-being in western societies. It seems pertinent to assess efficiency of chronic care and its impact on health equity. While equity in health as a general concept has ‘nearly universal ethical appeal’ and is reflected in health policy agendas worldwide, its conceptualisation and assessment remains less straightforward (Giacomini and Hurley, 2008: 285). It has been argued that the main contribution of economics to decision making in health care happens through the concepts of efficiency and equity as criteria to judge the use of scarce health care resources – but “there is far less agreement within economics about equity than about efficiency” (Morris et al, 2007: 18). Recent reviews have pointed to the multitude of definitions and approaches – and significant challenges – in dealing with health equity and social justice in health economic contributions to decision making in health care (Lane et al, 2017; Dukhanin et al, 2018)
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