Health Policy and Value Assessment Through the Health Equity Lens: How Far from Being Incorporated Routinely? An Environmental Scan of Frameworks and Policy Gaps.

Abstract

Health equity considerations are not yet regularly incorporated into value-based and policy decision making. Previous research has examined health equity as an integral element of value in policy making and health technology assessments (HTA), as well as barriers to the widespread adoption of health equity in these settings. This study identified and compared current frameworks addressing health equity in policy and healthcare decision making. An environmental scan was conducted in January 2024 (updated in August 2025) of MEDLINE (Ovid) and Embase databases and relevant HTA websites for frameworks and guidance documents (past 10 years) providing recommendations for incorporating health equity considerations into healthcare decision making. Recommendations were compared across 3 key aspects-planning, impact/incentives, and data quality/integrated analysis-based on the 2024 Advancing Health Equity and Whole-Person Care in the Centers for Medicare and Medicaid Services National Quality Strategy plan. Ten peer-reviewed articles and 8 reports from HTA agencies were included, representing frameworks and guidance documents from 10 countries. Themes emerging from the identified references included the need for planning for health equity incorporation at the planning level, which was unanimously recommended, followed by ensuring data representativeness and quality (as referred to by 11 documents); providing incentives was referenced by 5 frameworks. Existing frameworks identified in this environmental scan promote the expansion of value elements in technologies' assessment and provide structured guidance on the study design and outline the analytical capabilities and technical elements required to allow routine incorporation of health equity in decision making.