Cost and Quality in U.S. Health Care: A Systems Analysis
This paper examines the complex relationship between cost and quality in the U.S. health care system. It begins by defining quality and identifying the many cost drivers in health care, distinguishing those related to quality from those that are not. The paper then analyzes two key agencies — the FDA and the American Nurses Association — and their respective roles in shaping health care quality and cost. It further evaluates major initiatives, including health system benchmarking, electronic medical records, and the Affordable Care Act, assessing their potential to simultaneously improve quality and reduce costs. The paper concludes by considering implications for the nursing profession.
- Introduction: Defining Cost and Quality: Defining quality and identifying health care cost drivers
- Key Agencies Influencing Health Care Quality: FDA and ANA roles in quality and cost
- Initiatives Affecting Cost and Quality: Benchmarking, EMRs, and system-wide reform initiatives
- Implications for Nursing and the Future of U.S. Health Care: Future nursing roles amid health care reform
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What makes this paper effective
- The paper clearly distinguishes between cost drivers related to quality and those that are not, which grounds the analysis in a nuanced, evidence-based framework rather than oversimplification.
- It balances coverage of both public (FDA) and private (ANA) agencies, giving a well-rounded view of the institutional landscape shaping health care quality.
- The paper connects abstract policy initiatives — such as EMRs and benchmarking — to concrete, practical outcomes for nurses, making the argument relevant and applied.
Key academic technique demonstrated
The paper effectively uses compare-and-contrast analysis when evaluating the FDA and ANA. It identifies similarities (both influence quality) while clearly delineating differences (the FDA also directly affects cost, whereas the ANA does not). This technique adds analytical depth and avoids treating institutions as interchangeable.
Structure breakdown
The paper follows a logical four-part structure: it opens by defining key terms and establishing the cost-quality relationship; moves to an institutional analysis of the FDA and ANA; surveys major system-wide initiatives; and closes with forward-looking implications for the nursing profession. Each section builds on the previous one, moving from conceptual foundations toward practical conclusions.
Introduction: Defining Cost and Quality
The relationship between cost and quality in health care is not constant, but in general, higher costs are associated with the most modern equipment and drugs. However, to fully understand the connection between cost and quality, the term "quality" must first be defined, and the relevant cost drivers must be understood. There are many cost drivers in health care that are not related to quality — profits, administrative expenses, superfluous regulatory burden, information asymmetry, lack of competition, and more. Among the cost drivers that are related to quality are paying higher wages to acquire and retain the best staff, investment in equipment, facilities and supplies, information technology investments, innovation, and regulations that serve to improve quality.
Thus, while there is some correlation between cost and quality, it is not necessarily a strong correlation, and furthermore there may be instances where higher costs have nothing at all to do with quality (Fenton et al., 2012). Likewise, there can be quality improvements that have no effect — or even a negative effect — on the cost of health care.
References
ANA (2015). Statement of purpose. American Nurses Association. Retrieved June 23, 2015 from
Berwick, D., Nolan, T., & Whittington, J. (2008). The triple aim: Care, health and cost. Health Affairs, 27(5), 759–769.
FDA (2014). What we do. Food & Drug Administration. Retrieved June 23, 2015 from http://www.fda.gov/AboutFDA/WhatWeDo/
Fenton, J., Jerant, A., Bertakis, K., & Franks, P. (2012). The cost of satisfaction. JAMA Internal Medicine, 172(5), 405–411.
Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can electronic medical records systems transform health care? Health Affairs, 24(5), 1103–1117.
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