Health Economics and Policy

Background: Chronic conditions are associated with poorer health-related quality of life (HRQoL) and are more common in socioeconomically disadvantaged groups. We examined income-related inequality in health-related quality of life and quantified the contribution of chronic conditions to inequality in HRQoL among Australian adults. Methods: We analysed pooled cross-sectional survey data from 4953 Australian adults recruited through a non-probability online panel. We measured HRQoL using EQ-5D-5L utility scores calculated with the Australian value set. We measured income-related inequality using the Erreygers-corrected concentration index. Multivariable ordinary least squares regression estimated adjusted associations with utility, and decomposition analysis estimated the statistical contributions of chronic-condition burden and sociodemographic characteristics. Results: Higher EQ-5D-5L utility was modestly concentrated among participants in higher-income categories (Erreygers-corrected concentration index [ECI] = 0.0328; bootstrap SE = 0.0038; 95% bootstrap percentile CI 0.0251–0.0401; p < 0.001). Compared with participants reporting no chronic condition, those with multimorbidity had an adjusted utility score that was 0.151 points lower. Multimorbidity made the largest contribution to the observed inequality (27.63%), followed by not working (26.34%) and annual income above A$65,000 (19.27%). Conclusions: EQ-5D-5L utility was modestly concentrated among participants in higher-income categories. Multimorbidity and not working were the largest measured contributors. These cross-sectional findings describe statistical associations and do not establish cause and effect.

Acute cardiovascular care is among the most resource-intensive domains of contemporary healthcare. Major investments are concentrated in the index hospital episode, including emergency diagnostics, reperfusion or revascularization, intensive monitoring, specialist pharmacotherapy and multidisciplinary stabilization. Yet a substantial share of this value may be lost after discharge, when patients enter fragmented outpatient pathways characterized by delayed follow-up, medication discrepancies, unclear accountability and inconsistent implementation of secondary prevention. This paper uses the discharge cliff as an organizing metaphor for that phenomenon. We argue that the discharge cliff is not only a clinical problem but also a health-economic and sustainability problem. When responsibility becomes discontinuous after discharge, high-cost acute gains are exposed to avoidable erosion. The result is recurrent emergency use, repeat diagnostic cascades, duplicated medicines work, potentially preventable rehospitalization and additional material consumption. These consequences are relevant after acute myocardial infarction, decompensated heart failure, cardiogenic shock survivorship and stroke with cardiovascular complications, where the post-discharge period is both vulnerable and management intensive. Drawing on cardiovascular guidelines, outcomes research, policy documents and sustainability literature, we organize the synthesis around three recurring governance mechanisms: discontinuity of accountability, misaligned reimbursement incentives and weak post-acute feedback loops. We then propose a framework of post-acute cardiovascular stewardship. Core levers include structured discharge-to-follow-up pathways, pharmacist-supported medicines optimization, early specialist review, digital monitoring for high-risk patients, accountable transition metrics, and bundled or episode-based payment models. Clinical continuity and economic stewardship form the operational core of the framework; environmental resource use is included as an emerging, cross-cutting dimension whose pathway-level quantification remains less mature. The vulnerability of the post-discharge period is well established. The contribution here is not a new clinical phenomenon but a reframing of that established failure as a problem of value preservation and governance, and its operationalization into accountable ownership, episode-level measurement and reimbursement design. The sustainable future of high-intensity cardiovascular care depends not only on saving lives in hospital, but also on preserving the value generated there once the patient returns to community care.

Traditional benefit–cost analysis (BCA) summarizes the average net social benefit of a policy but often obscures how benefits and costs are distributed across groups. This is a major limitation in health policy settings, where decision-makers must assess both efficiency and equity. This article develops an integrated equity-weighted causal benefit–cost analysis (IEW-BCA) framework for equity-conscious policy evaluation. The framework links subgroup-specific causal effect estimates, explicit valuation functions, and equity weights within a single evaluation pipeline suitable for applied policy appraisal. It makes three contributions: first, it provides an implementable structure for combining causal heterogeneity with welfare-consistent valuation; second, it introduces a compound equity vector and associated weighting functions that extend income-based schemes and can be interpreted, under standard conditions, as a first-order approximation to a broad class of social welfare functions; and third, it develops equity-oriented summary tools, including a causal equity gradient and related dominance criteria, to improve transparency about distributional impacts. A stylized example illustrates implementation, and the discussion outlines implications for uncertainty, sensitivity analysis, and potential application in health economics, public health policy, and regulatory evaluation.