Health Affairs June 7, 2023
Improving health equity in the US will require changing health care payment. But despite the success of value-based payments in resetting expectations away from volume-based reimbursement toward quality and cost efficiency, these arrangements, historically, have not been designed to combat longstanding health inequities.
In fact, there is growing recognition that even as value-based payment arrangements attempt to promote financial sustainability and better care, they can unintentionally entrench or exacerbate existing health inequities. One fundamental reason is that value-based models are founded on accountability for patient outcomes and cost, with participating clinicians and hospitals earning financial bonuses for hitting cost and quality targets. This design can deter hospitals and clinicians from caring for patients whose costs and quality of care appear...
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