Community-based healthcare for addressing health inequalities? A systematic scoping review

Background

There is an increasing global focus on moving healthcare provision away from hospitals and into communities, with the goal of reducing health inequalities. This study aimed to ascertain which non-urgent hospital-based healthcare services can be shifted to community settings, and to understand the impact of these shifts on health inequalities.

Methods

A systematic scoping review of four databases, including extensive hand searching, was conducted. Inclusion criteria were qualitative or quantitative peer-reviewed English-language studies (published from 2015) and conducted in high-income countries. After deduplication, titles and abstracts were screened, followed by the full texts. Relevant information was extracted from included studies, charted and narratively summarised. The reported outcomes of the community-based services were mapped onto the Quadruple-Aim Framework.

Results

Of the 28 included studies, the m reported benefits of community-based healthcare, including reduced healthcare spending, better management of long-term conditions, and shorter time to diagnosis. Most studies did not report any drawbacks or limitations. Only seven studies examined the impact of community-based services on health inequalities, and only two demonstrated improvements for systemically disadvantaged groups.

Conclusions

Moving services from hospitals to community settings may have overall benefits; however, there remains limited evidence to demonstrate the impact on health inequalities. Future service redesign should include equity-focused evaluation to assess whether community-based models improve access and outcomes for disadvantaged groups.

Key messages

• Community-based healthcare may reduce costs, improve long-term condition management, and shorten time to diagnosis.

• Evidence remains limited on whether shifting hospital services into communities reduces health inequalities.