Scales balancing efficiency and equity in healthcare.

The Equity Equation: Why What's Measured Matters in Healthcare

Theo Raines in Health & Wellness December 2025 • 4 min read.

"Unveiling the Hidden Factors Influencing Health Technology Decisions and How We Can Ensure Fairness for All."

In the realm of healthcare, decisions about funding new technologies are often driven by quantitative evidence. Policy makers meticulously examine comparative effectiveness, cost-effectiveness, and budget impact— what we broadly term "efficiency" criteria. These metrics provide a seemingly objective basis for allocating resources, ensuring the greatest return on investment.

However, a critical dimension often receives less attention: equity. How do these decisions impact different population groups? Who benefits, and who bears the burden? Are those who gain already better off in terms of health compared to the rest of the population? These "equity" criteria, while ethically crucial, are often harder to quantify, leading to their marginalization in the decision-making process.

Two recent studies highlighted this imbalance, suggesting that the over-reliance on measurable efficiency metrics may inadvertently perpetuate inequities in healthcare access and outcomes. These studies underscore the adage that “what gets measured, gets done,” prompting a crucial discussion about how to better integrate equity considerations into health technology assessment (HTA).

The Quantifiable vs. The Qualitative: A Dangerous Divide?

Scales balancing efficiency and equity in healthcare.

Globally, healthcare decision-makers face the challenge of balancing limited resources with the ever-increasing demand for new technologies. The allure of quantitative data is undeniable. Metrics like cost-effectiveness provide a seemingly straightforward way to compare options and maximize health benefits for the population as a whole.

However, this focus on "efficiency" can overshadow critical equity considerations. Factors like the distribution of benefits, the needs of vulnerable populations, and fairness in access to care are often difficult to translate into neat numerical values. As a result, they risk being overlooked in favor of more easily measurable outcomes.

Efficiency: Focuses on maximizing the overall health benefit from available resources.
Equity: Aims to ensure fair distribution of healthcare resources and outcomes across different population groups.

Two recent studies published in the Israel Journal of Health Policy Research shed light on this critical issue. These studies highlight how an over-reliance on quantifiable efficiency metrics can inadvertently marginalize equity considerations in healthcare decision-making. The findings suggest that the mantra “what gets measured, gets done” holds true, potentially leading to inequitable outcomes.

Moving Towards a More Equitable Future

The path forward involves a fundamental shift in how we approach health technology assessment. We must prioritize the development and application of methods that can quantify equity outcomes alongside traditional efficiency metrics. Distributional Cost-Effectiveness Analysis (DCEA) and approaches that measure and value severity of illness offer promising avenues for integrating equity into decision-making frameworks. By embracing these tools, we can ensure that healthcare decisions reflect our values and promote a fairer, more just healthcare system for all.

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This article is based on research published under:

DOI-LINK: 10.1186/s13584-017-0162-3, Alternate LINK

Title: Equity In Hta: What Doesn’T Get Measured, Gets Marginalised

Subject: Public Health, Environmental and Occupational Health

Journal: Israel Journal of Health Policy Research

Publisher: Springer Science and Business Media LLC

Authors: Richard Cookson, Andrew J. Mirelman

Published: 2017-07-10

Everything You Need To Know

What does "efficiency" mean in the context of healthcare technology decisions?

In the context of healthcare technology assessment, "efficiency" refers to the focus on maximizing the overall health benefit derived from the available resources. It involves evaluating metrics like cost-effectiveness and comparative effectiveness to ensure the greatest return on investment. While efficiency is important for making the most of limited resources, an overemphasis on it can overshadow equity considerations, potentially leading to decisions that benefit some population groups more than others.

What is meant by "equity" in healthcare, and why is it important?

"Equity" in healthcare means ensuring the fair distribution of healthcare resources and outcomes across different population groups. It involves considering factors like the needs of vulnerable populations, fairness in access to care, and the distribution of benefits from new technologies. Equity is ethically crucial because it addresses existing disparities and aims to create a more just healthcare system where everyone has the opportunity to achieve their best possible health. It is often harder to quantify than efficiency, leading to it being marginalized.

How can focusing on measurable data affect equity in healthcare?

The focus on measurable data, particularly in the form of "efficiency" metrics like cost-effectiveness, can inadvertently marginalize "equity" considerations. This happens because efficiency metrics are often easier to quantify and compare, leading to an over-reliance on them in decision-making. As a result, important equity factors like the distribution of benefits, the needs of vulnerable populations, and fairness in access to care may be overlooked, potentially perpetuating existing health disparities.

What is Distributional Cost-Effectiveness Analysis (DCEA), and how can it help?

Distributional Cost-Effectiveness Analysis (DCEA) is a method that can quantify equity outcomes alongside traditional efficiency metrics. It allows decision-makers to assess how the costs and benefits of healthcare technologies are distributed across different population groups. By incorporating DCEA into health technology assessment frameworks, it is possible to make more informed decisions that promote both efficiency and equity, leading to a fairer and more just healthcare system for all. Approaches that measure and value severity of illness also offer promising avenues for integrating equity.

What is the significance of the phrase "what gets measured, gets done"?

The statement "what gets measured, gets done" is important because it highlights the potential consequences of focusing solely on quantifiable metrics. If only efficiency is measured and prioritized, equity considerations may be neglected. This can lead to decisions that inadvertently perpetuate inequities in healthcare access and outcomes. The statement underscores the need to develop and apply methods that can quantify equity outcomes alongside traditional efficiency metrics, ensuring that both are given due consideration in healthcare decision-making.