Starfield, B.

Abstract: This essay provided the introduction to a workshop in Bellagio, Italy, on the subject of translating research into policy for equity in health. The essay first defines equity in a way that facilitates its assessment and monitoring and then summarizes evidence from existing research. Directions for developing policy strategies follow from these principles. The role of health services in influencing the distribution of health in populations is discussed in the special context of primary-care-oriented health systems that are, at the same time, more effective, more efficient, and more equity producing than is the case for specialist-dominated health systems.

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Abstract: OBJECTIVE: To review the extent to which the literature supports the position that a medical home is important and to review the extent to which insurance is related to having a medical home. METHODS: A review of literature concerning the benefits of a medical home on effectiveness, costs, and equity (reducing disparities) was conducted. RESULTS: International and within-nation studies indicate that a relationship with a medical home is associated with better health, on both the individual and population levels, with lower overall costs of care and with reductions in disparities in health between socially disadvantaged subpopulations and more socially advantaged populations. Although important in facilitating use overall, insurance does not guarantee a medical home. CONCLUSIONS: A medical home, with its 4 key features, provides better effectiveness as well as more efficient and more equitable care to individuals and populations. A concerted attempt to provide a means of universal financial access as well as a medical home should be of high priority for the United States.

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