Health Care Cost and Quality
Instructions: Describe the relationship between health care cost and quality. Address the following:
1.Select one public agency and one private agency and differentiate their roles and major activities in addressing cost and quality in health care.
2.Analyze current and projected initiatives to improve quality while simultaneously controlling costs. Describe any unintended consequences.
3.Synthesize implications for staff nurses and advanced practice nurses, including evidence-based practice, relative to cost and quality.
Health Care Cost and Quality
The issue of striking a balance between the quality of health being provided to the patients and the cost of such health is one of great importance to the society. A large population of persons across the United States, are unable to afford a high cost of medical healthcare, yet they form the same population that is largely exposed to conditions that undermine their health. In view of promoting equal access to quality health care, both public and private agencies have established initiatives that are directed at advocating for and facilitating low-cost quality healthcare. This paper reviews the contributions of the Agency for Healthcare Research and Quality (AHRQ) and the Institute for Healthcare Improvement (IHI) towards facilitating low cost quality healthcare.
Roles in Addressing Cost and Quality in Health Care
Both the public and the private sector have a role to play towards promoting accessibility of quality health care at a low cost, with a collaboration between the two sectors proving to be a highly effective approach towards the same. The Agency for Healthcare Research and Quality (AHRQ) is a branch of the U.S. Department of Health and Human Services responsible for research. As such, the agency has a role to play in engaging in research that is designed to facilitate improvements in terms of the quality of care, patient safety, healthcare cost, access to services that are essential, and reduced medical errors within the health care system (AHRQ, 2016). From the private sector is the Institute for Healthcare Improvement (IHI), which is a non-profit organization that was established to promote improvements across the health care systems, in terms of value and quality. The measures of improvement by the institute include improved clinical outcomes, better health status, lower cost, ease of use, increased access, and increased individual and community satisfaction with health care services (IHI, 2016).
Initiatives to Improve Quality and Control Costs
The Agency for Healthcare Research and Quality (AHRQ) has established various research initiatives that have been directed at identifying the factors that impede the delivery of quality health care, and advocated for approaches to facilitate improvements. The agency’s advocacy for health care system redesign has greatly contribute towards improvements in the effectiveness, efficiency, and quality of patient care (AHRQ, 2016). One of the project areas that the agency has been involved in, in system redesign, is the area of cultural competency and health literacy. This initiative has been aimed at improving care among health care providers by removing any obstacles that are related to literacy, such as those that range from ethnic, racial, linguistic, and cultural differences (Aiken, 2012). The Agency also developed a hospital guide aimed at reducing Medicaid readmissions. By facilitating reductions in readmissions among Medicaid covered patients, the agency facilitates improvements in terms of quality of care offered by healthcare providers, in engagement with the patients and their families. Reduced readmissions for such patients means reduced cost of healthcare.
On the other hand, the IHI has established a framework referred to as the ‘Triple Aim’, which is aimed at improving health care services (IHI, 2016). The agency believes that there is need for new system designs to be embraced in order to facilitate improvements in terms of three dimensions, which include: improvements in the experience of patients in care, including their satisfaction with the quality of care; improvement in terms of population health, and reduced health care cost per capita (IHI, 2016). The IHI believes that it is important for these dimensions to be pursued simultaneously as they are interrelated. The agency advocates for systemic change across the health care in view of promoting the three dimensions and ensuring that all the members of the public are able to access quality healthcare at a low cost.
Implications for Nurses
The efforts put in place by both the private sector and public sector agencies towards promoting quality, low-cost health care accessibility among members of the public have far-reaching implications for health care providers. Some of the initiatives, such as those put in place by the AHRQ include training approaches that are aimed at improving their competencies. Low literacy levels are associated with poor patient outcomes and low quality care (Berkman, Sheridan, Donahue, Halpern, & Crotty, 2011). As such, proper training of nurses ensures improvements in their literacy skills. In addition, by developing guidelines, the agencies provide nurses with a framework upon which they can base their practices and hence facilitate improvements in terms of the quality of care provided to the patients. Through concept design, agencies such as the IHI are able to provide nurses with information that is important to the improvement of the quality of their health care practices, including the importance of focusing on both individuals and families in the health care practice (IHI, 2016). The agencies are also able to establish frameworks based on which the structures and services of primary health care can be redesigned to facilitate improvements in terms of quality of care, in view of reducing cost of care.
It is evident that initiatives directed at facilitating patient care should be simultaneously carried out together with those aimed at reducing the cost of care. By improving their input, both public and private sector agencies can be able to effectively initiate approaches that would ensure that the disparities that exist between the cost of care and the quality of care are eliminated and that members of the public are able to have equal access to quality health care services, regardless of their resources.
AHRQ. (2016). Health Care/System Redesign. Retrieved from Agency for Healthcare Research and Quality: http://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/index.html#tiptop
Aiken, L. H. (2012). Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ, 344, 1717.
Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low Health Literacy and Health Outcomes: An Updated Systematic Review. Annals of Internal Medicine, 155(2), 97-107.
IHI. (2016). The IHI Triple Aim. Retrieved from Institute for Healthcare Improvement: http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx