Single Pay Journal

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Iron Triangle" Of Care, Cost, And Quality

Prior to explicating the particular direction that the health care system in the United States needs to take to consistently offer high levels of health care access at reasonable costs with substantial quality, it is necessary to understand the so-called iron triangle conundrum. The typical view of health care in the U.S. is that these three important factors (cost, quality and access) inevitably produce a detrimental effect upon one another. This viewpoint propounds the notion that increasing access to health care will inevitably drive up the costs associated with it, and quite possibly produce a noxious effect on the quality of such care. Conversely, there is a popularly held belief that reducing costs for health care will lead to a definite reduction in the quality of care delivered. Essentially, the iron curtain view of these three aspects of health care maintains that any improvement in one of these factors will inevitably adversely affect the others. However, an examination of a number of different sources supports the idea that by shifting the focus of how health care is practiced in this country, and by incorporating certain elements of foreign health care systems, the iron triangle can be broken and access, cost and quality can all improve.

Perhaps the single most important determinant in an improvement in cost, quality and access to healthcare is changing the definition of what good health care is. Good health care is that in which wellness is supported and encouraged. Quite often, however, within America good health care is considered from an industrial perspective in which many believe that access to a number of different aspects of managing diseases is the apex of health care. Such a notion is simply not true and functions as a means for corporations and industries to essentially profit from the poor health of others. Instead, it is much more important to emphasize the sort of health care that encourages health and discourages illness from ever happening. Many aspects of disease management become superfluous when wellness is emphasized. In fact, there are several expensive and lengthy medical procedures that can be prevented or take place rarely when individuals spend the proper time ensuring that they remain well. The subsequent quotation readily supports this statement.

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"…the cost structures American health care cannot be changed without re-examining the fundamental assumptions about what it means to be healthy. Only by shifting the focus of health-care dollars from disease management to empowering individual wellness can costs be reduced…while expanding the quality of…life" (Farrell, 2012).

The direction that the current health care system needs to go in, therefore, is one in which preventive care is emphasized. Revealingly, there are numerous signs that the health care system is actually attempting to emphasize this aspect of health care. There are numerous preventive services that patients in the U.S. can currently obtain free of charge. In fact, this switch in service access and cost is one of the fundamental principles of the Affordable Health Care Act, the mere mentioning of which instantly conjures up images of the iron triangle. Representatives from insurance companies to health care providers have referenced the fact that because of increased access to health care and benefits such as the aforementioned preventive services, the cost for health care will inevitably increase for those who are not enrolled in this act (Finney, 2013) -- creating a situation in which those with more monetary resources are ultimately paying for the services of those with less financial resources. In many respects these individuals are right and their concerns will be addressed in the next paragraph and in the remainder of the document. However, the fact still remains that focusing on prevention results in a healthier population (which boosts quality) that will have less need for expensive curative measures -- which will also help to restore the balance to some of the costs of the current system in the wake of the Affordable Care Act.

Access to health care and quality to health care can increase by focusing on prevention and eschewing more costly curative procedures. Yet the current health care system….....

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