An equity lens in healthcare performance measurement: more than equity gains?

This Ph.D. dissertation discusses equity in healthcare performance measurement at the local level. Each of the three chapters of this dissertation constitutes an independent research output, answering stand-alone research questions. Chapter 1 is a systematic narrative review on the equity lens in healthcare performance measurement at the local level. The chapter addresses how measuring equity performance can contribute to equity improvement, as well as the impact of initiatives based on equity performance measurement on equity itself. Chapters 2 and 3 report empirical evidence from Tuscany, Italy. More specifically, Chapter 2 examines the association between educational level (i.e. a proxy for socioeconomic status) and 30-day mortality and readmission among patients hospitalized for acute myocardial infarction in Tuscany. Chapter 3 assesses the potential impact of improving equity on financial sustainability and quality of care through a simulation that was applied to the performance indicators of the heart failure clinical pathway in Tuscany. The simulation quantified how many resources could have been reallocated if the performance of patients with a low education had been equal to the performance of patients with a high education. A common ground among chapters is the identification of the “non-equity gains” related to measuring and improving equity in health care.