MMI health equity questions on fairness and access to care

Who gets care, and who gets less of it, is decided by rules that look fair on paper. MMI health equity questions test whether you can see the person a rule leaves out and say what you'd change from within your role. In each scenario in this topic, a rule that treats everyone the same lands hardest on the people with the least.

What these questions test

Equality is treating everyone the same. Equity is giving each person what they need to reach the same outcome, which can mean treating people differently. Raters score whether you can tell the two apart and say which one a situation calls for.

They also listen for the social determinants of health, the conditions of income, housing, education, transport and work that shape health before a person reaches a clinic. Cultural humility is the practice of examining your own assumptions about a community before you act on them. The question on a premed volunteer trip abroad scores it.

How to approach them

1. Name who is left out and the barrier that does it. The barrier is cost, distance, time, technology, language or a rule applied to everyone, and naming it shows you understand the mechanism rather than only the group.
2. Decide whether the situation needs equality or equity. First-come sign-up for free tutoring spots on a weekday morning is equal, and it hands the spots to families with a free parent and a fast connection. Say which rule would change that and what it costs the families who'd lose out.
3. Count the trade-off out loud. Replacing two rural clinics with video visits shortens the regional wait and removes in-person care from the people least able to use video, so say who gains, who loses and whether the losers can be protected.
4. Act within your role, then escalate. A pharmacy assistant can't hand out medication to a customer whose coverage has lapsed, but can bring in the pharmacist, ask about an emergency supply and help with the coverage problem. Check whose interest a plan serves, too: a two-week clinic where premedical students give injections serves the applicants before it serves the patients.
5. For the right-to-health-care prompt, define the right before you defend it: what it includes, what it leaves out and who pays. In an MMI, expect the follow-up to ask where your version runs out of money. For the personal story on a panel, pick a rule you saw land unevenly and say what you did.

Common mistakes

• Offering equal treatment as the fair answer misses that the station was built to show where that fails.
• Describing the people a rule leaves out as a problem to manage, rather than as people with a claim on the service, shows the rater how you'd talk about patients.
• Promising a fix outside your authority trades the rule for a gesture.
• Ignoring what the fair option costs, and who pays it, makes the answer sound untested.