Addressing inequities in access to healthcare: 4 recommendations for biopharma manufacturers

In this market access update, we explore the common barriers to accessing healthcare for minority, vulnerable, and excluded groups and how these barriers have been exacerbated by the Covid-19 pandemic. We also offer 4 recommendations for pharmaceutical and biotechnology manufacturers seeking to address inequities in access to healthcare: 

1. Use social determinants of health and electronic health records in forecasts of health outcomes.
2. Help to address inequities in the social determinants of health.
3. Ensure that clinical trial outcomes are representative of the entire population.
4. Develop innovative collaborations with all stakeholders to determine value.

What does inequity in health mean? 

When developing strategies for access to healthcare, the terms health inequality and inequity are sometimes confused or used interchangeably. They shouldn’t be, it’s important to recognize the difference between inequality and inequity:  

• Inequality in health refers to the uneven distribution of health and/or resources due to factors such as genetics. 
• Inequity in health refers to differences arising from social determinants such as governance or culture.
  
  

“Health inequity is the unfair and avoidable differences in health status seen within and between countries.”  

Source: World Health Organization. “Social Determinants of Health” 

The 2 primary factors that contribute to inequities in health

The World Health Organization identifies two main clusters of root causes of health inequity.  

The first is the intrapersonal, interpersonal, institutional, and systemic mechanisms that impact access to healthcare differentially across race, gender, class, sexual orientation, gender expression, and other determinants of individual and group identity.  

The second is the unequal allocation of power and resources, including goods, services, and societal attention, which result in unequal social, economic, and environmental conditions. These are called the social determinants of health. 

Examples of social determinants of health  

The social determinants of health (SDoH) are the non-medical factors that influence 30–55% of health outcomes1 and affect access to healthcare. They include the conditions in which people are born, grow, work, live, and age, and the wider set of factors shaping the conditions of daily life. These wider factors include economic policies and systems, development agendas, social norms, social policies, and political systems. 

The NCCN Guidelines are “a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment”.² The framework has already been applied to more than 50 different cancer types. Although the Evidence Blocks themselves are visual and accessible to patients, the accompanying assessment is heavyweight material, suitable for professional use only. 

Source: World Health Organization. “Social Determinants of Health” 

The common barriers to accessing healthcare for minority, vulnerable, and excluded groups   

A negative impact of the social determinants of health on minority, vulnerable, and excluded groups is the barriers and difficulties they face in accessing and engaging with healthcare services.  

Common barriers to accessing healthcare are lack of knowledge about the healthcare system, negative previous experiences, language concerns, transport constraints, stigma, and discrimination.  

For example, NHS England2 highlight that one exacerbating factor is the healthcare providers who lack full understanding of charging regulations. This can mean they refuse to register patients who are actually eligible for healthcare.   

The impact of the Covid-19 pandemic on inequities in access to healthcare  

Although the main barriers to access remained largely the same during the Covid-19 pandemic, financial barriers and lack of access to digital technology were more prevalent.3-5  

Doctors of the World3 identified that digital exclusion was a key barrier to access healthcare services for some groups during the pandemic. Social determinants of health such as low income meant that some patients were unable to access computers, smartphones, or the internet for healthcare information or virtual-consultations, with some patients having to choose between investing in access to the internet or purchasing basic essentials.  

4 recommendations for manufactures seeking to overcome inequities in access to healthcare  

1. Use social determinants of health and electronic health records in forecasts of health outcomes  
   As population health becomes a growing focus of healthcare delivery, the social determinants of health (SDoH), explained above, become increasingly important for identifying potential upstream drivers of poor outcomes and high costs. 
   
   Electronic health records (EHRs) offer great potential to aggregate, analyze, and integrate individual- and community-level data across settings and over time. Integrating SDoH into EHRs can provide a broader perspective on potential drivers of a patient’s health status and can help identify both upstream and downstream approaches for improving the effectiveness of care. 
   
   For example, individual-level income, employment, education, and housing have been found by Chen and colleagues6 to contribute to the prediction of 30-day re-admissions, and HIV risk assessment can be improved by considering housing stability, drug use, and high-risk sexual activities.  

2. Help to addressinequities in the social determinants of health 
   Pharmaceutical, biotechnology, and medical device manufacturers have a timely opportunity to help tackle socio-economic inequities that drive down the real-world efficiency of their products.  

“Forward-thinking manufacturers will gain market distinction with strategic initiatives aimed at ameliorating social risk factors, from clinical trials through FDA approval and beyond.” 

Source: Hennessey, M. Pharma’s pivotal role in social determinants of health.  

Opportunities exist for manufacturers to design innovative products and services that help mediate the impact of the SDoH, and thus facilitate appropriate access and adherence for minority, vulnerable, and excluded groups.  

Source: Hennessey, M. Pharma’s pivotal role in social determinants of health.  

3. Ensure that clinical trial outcomes are representative of the entire population  
   By making changes to how trials are designed, a more inclusive population can be included, which will allow for identification of the role SDoH plays in the efficiency of treatment. 
   
   Manufacturers have opportunities during the clinical trial process to address social factors that may inhibit participation by diverse populations. A lack of diversity in clinical trials thwarts the goal of precision medicine to provide therapies that account for factors like ethnicity, gender, genetics, race, and SDoH. 

Sources: 1. Bonevski B, Randell M, Paul C, et al. Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups. 2. Kantor, E. How to move from diversity to inclusion in medical research.     

4. Develop innovative collaborations with all stakeholders to determine value
   Continual collaboration with all stakeholders, including patients, providers, and payers, across the spectrum of activities, beginning with clinical trials and continuing throughout the patient journey, will allow manufacturers to differentiate themselves and deliver distinct value.
   
   As drug pricing comes under scrutiny from politicians, policymakers, and consumers, there has been a move by some pharmaceutical and life sciences companies to start experimenting with value-based models, which align the price of treatment to clinical or economic outcomes. 

“In the shift from volume to value, understanding the complexity of patients’ lives is re-shaping drug development and commercialization.” 

Source: Addressing the determinants of health: What is pharma’s role?  

In the shift to a value-based system, drug development and commercialization is being shaped by increasing patient engagement and a better understanding of patients’ lives. Real-world evidence that shows the value of healthcare in the context of people’s lives – including the patient groups who didn’t participate in the trial – is needed.  

Keeping a close pulse on the evolving healthcare landscape  

If one thing is clear, the path ahead requires us all to keep our fingers on the pulse of inequities in access to healthcare. PRMA Consulting will continue to interact with decision-makers and stakeholders in international systems. We will help you stay informed by sharing strategies for market access success in future articles; please subscribe for updates. 

Further reading

1. World Health Organization. Social Determinants of Health.   
2. NHS England. Improving GP registration among socially excluded groups. 
3. Doctors of the World. Barrier to wellbeing: Migration and vulnerability during the pandemic. (2021) 
4. Doctors of the World. A rapid needs assessment of excluded people in England during the 2020 COVID-19 pandemic. (2020) 
5. Medact, Migrants Organise, New Economics Foundation. Patients not passports: Migrants’ access to healthcare during the coronavirus crisis. (2020)  
6. Chen M, Tan X,PadmanR. Social determinants of health in electronic health records and their impact on analysis and risk prediction: A systematic review (2020).