The iron triangle of care, cost, and quality

¶ … 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.

"…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 can engender even greater access to health care by substantially revamping the structure of that system in such a way that the aforementioned complaints about rising costs as created by the Affordable Health Care Act are suitably addresses. Te key component to ameliorating these facets of the iron triangle is to incorporate certain aspects of a single-payer health care model. It is critical to realize that there are many countries within the developed, Westernized world that have been utilizing such a model for a substantial length of time and successfully procuring the wellness of their populations. Moreover, there are numerous characteristics of a single-payer model which account for the issues denoted by the iron triangle, such as that:

Under a properly designed single payer model, access is improved by removing financial barriers to care for absolutely everyone. The comprehensive design features of single payer improve quality, simply stated, by ensuring that patients receive the care that they need while reducing or eliminating care that is detrimental. And costs are the forte of the single payer system (McCanne, 2012).

A single payer system is one in which there is one payer for the health care in a country (typically the government), yet there is still private delivery of care. Typically, everyone in the country is granted health care at virtually no cost, which addresses the crucial facets of access and cost in the iron triangle.

One of the most important components of the previous quotation from McCanne is the fact that in order for the access and cost elements of health care to improve, such a single-payer model must be "properly designed." One of the key characteristics of such a single payer system that could also help to improve the third part of the iron curtain (quality) is a focus on preventative care. Such a system with a focus on prevention could not only render more expensive disease management procedures no longer necessary, but also increase the wellness of the general population by emphasizing staying healthy instead of curing itself once it is no longer healthy. Furthermore, the distinct aspects of the single-payer system can be significantly enhanced by implementing it so that budgets for particular areas of the system -- perhaps by state, municipality, or even county -- are administered based on the population. Donald Light (2012) references the transition of the Veterans Health Administration (VHA) to just such a system in the following quote, in which he notes that