# Beyond Semantic Similarity: A Component-Wise Evaluation Framework for Medical Question Answering Systems with Health Equity Implications

arXiv: https://arxiv.org/abs/2604.19281 · HTML: https://mlsanity.com/paper/2604.19281/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 23 of its 69 references that are in the map.
- First posted on arXiv 21 Apr 2026.

## Builds on (most cited first, 23 of 23)

- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [Training language models to follow instructions with human feedback](https://mlsanity.com/paper/2203.02155/) (2022)
- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Large Language Models are Zero-Shot Reasoners](https://mlsanity.com/paper/2205.11916/) (2022)
- [TruthfulQA: Measuring How Models Mimic Human Falsehoods](https://mlsanity.com/paper/2109.07958/) (2021)
- [Learning to summarize from human feedback](https://mlsanity.com/paper/2009.01325/) (2020)
- [Pre-train, Prompt, and Predict: A Systematic Survey of Prompting Methods in Natural Language Processing](https://mlsanity.com/paper/2107.13586/) (2021)
- [REALM: Retrieval-Augmented Language Model Pre-Training](https://mlsanity.com/paper/2002.08909/) (2020)
- [A Survey on Bias and Fairness in Machine Learning](https://mlsanity.com/paper/1908.09635/) (2019)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [PubMedQA: A Dataset for Biomedical Research Question Answering](https://mlsanity.com/paper/1909.06146/) (2019)
- [Leveraging Passage Retrieval with Generative Models for Open Domain Question Answering](https://mlsanity.com/paper/2007.01282/) (2020)
- [Publicly Available Clinical BERT Embeddings](https://mlsanity.com/paper/1904.03323/) (2019)
- [On Faithfulness and Factuality in Abstractive Summarization](https://mlsanity.com/paper/2005.00661/) (2020)
- [Evaluating the Factual Consistency of Abstractive Text Summarization](https://mlsanity.com/paper/1910.12840/) (2019)
- [SummaC: Re-Visiting NLI-based Models for Inconsistency Detection in Summarization](https://mlsanity.com/paper/2111.09525/) (2021)
- [Can large language models reason about medical questions?](https://mlsanity.com/paper/2207.08143/) (2022)
- [Evaluating Factuality in Generation with Dependency-level Entailment](https://mlsanity.com/paper/2010.05478/) (2020)
- [GeneGPT: Augmenting Large Language Models with Domain Tools for Improved Access to Biomedical Information](https://mlsanity.com/paper/2304.09667/) (2023)
- [Self-Discover: Large Language Models Self-Compose Reasoning Structures](https://mlsanity.com/paper/2402.03620/) (2024)
- [Assessing The Factual Accuracy of Generated Text](https://mlsanity.com/paper/1905.13322/) (2019)
- [What's in a Summary? Laying the Groundwork for Advances in Hospital-Course Summarization](https://mlsanity.com/paper/2105.00816/) (2021)
- ["You Cannot Sound Like GPT": Signs of language discrimination and resistance in computer science publishing](https://mlsanity.com/paper/2505.08127/) (2025)

## Abstract (arXiv)

The use of Large Language Models (LLMs) to support patients in addressing medical questions is becoming increasingly prevalent. However, most of the measures currently used to evaluate the performance of these models in this context only measure how closely a model's answers match semantically, and therefore do not provide a true indication of the model's medical accuracy or of the health equity risks associated with it. To address these shortcomings, we present a new evaluation framework for medical question answering called VB-Score (Verification-Based Score) that provides a separate evaluation of the four components of entity recognition, semantic similarity, factual consistency, and structured information completeness for medical question-answering models. We perform rigorous reviews of the performance of three well-known and widely used LLMs on 48 public health-related topics taken from high-quality, authoritative information sources. Based on our analyses, we discover a major discrepancy between the models' semantic and entity accuracy. Our assessments of the performance of all three models show that each of them has almost uniformly severe performance failures when evaluated against our criteria. Our findings indicate alarming performance disparities across various public health topics, with most of the models exhibiting 13.8% lower performance (compared to an overall average) for all the public health topics that relate to chronic conditions that occur in older and minority populations, which indicates the existence of what's known as condition-based algorithmic discrimination. Our findings also demonstrate that prompt engineering alone does not compensate for basic architectural limitations on how these models perform in extracting medical entities and raise the question of whether semantic evaluation alone is a sufficient measure of medical AI safety.