Advancing equity and value in United States healthcare: an umbrella review

The United States (U.S.) healthcare system consistently underperforms in equity and value compared to peer countries. Socially disadvantaged groups, such as racial and ethnic minorities, refugees, and low-income populations, experience worse access to healthcare and poorer health outcomes. This issue highlights the need for targeted interventions to reduce disparities and improve healthcare quality in both public health and clinical practice. This scoping review aims to map existing literature on interventions that promote healthcare equity and value in the US, focusing on access to healthcare and health outcomes for disadvantaged populations.

A scoping review of systematic reviews was conducted to map literature on high-value, equitable healthcare in the U.S. Using the Arksey and O'Malley framework and PRISMA-ScR guidelines, the review focused on systematic reviews of interventions, strategies, and policies promoting healthcare equity and value published between 2018 and 2023 that addressed U.S.-based healthcare. A two-step article selection process and qualitative synthesis of findings were employed.

The review synthesized 54 studies, comprising mostly systematic reviews, scoping reviews, and meta-analyses. These studies focused on disadvantaged populations, including racial and ethnic minorities, refugees, and low-income groups. Interventions were categorized into four themes: community engagement and outreach (e.g., use of community health workers), culturally-tailored interventions (e.g., language-concordant care), technology adoption (e.g., digital health tools), and policy reforms (e.g., Medicaid expansion). Findings highlighted the critical role of community health workers and culturally responsive programs in improving access to care and health outcomes for disadvantaged populations. However, most interventions, including these approaches, aim to improve health outcomes measured across whole populations, rather than healthcare gaps between groups within populations.

This review underscores the importance of culturally tailored interventions, community engagement and outreach, and policy reforms in addressing equity and value in healthcare. There is a significant gap in research directly tackling healthcare inequities. Future research should focus on system accountability, addressing structural inequities, and developing new care models to enhance equity and value.