Relationship between Quality and Cost of Health Care in the United States
A review of healthcare expenditure within the United States, it is evident that the government has been spending more funds with the intention of ensuring that the quality of healthcare increases for every individual. According to Burke & Ryan (2014), health care is extremely costly in the United States when compared to some of the other developed countries where the level of government expenditure per capita is between 50% and 200% higher than that of other nations. The United States federal government is expected to spend more within the coming years in health care when compared to any other sector of the country's economic structure. However, the critical question remains whether this has had a direct impact towards improving the quality of health services in the country, which is a critical question that this section will seek to answer.
The United States health care system is structured based on two fundamental pillars, cost and quality, each of which seeks to define the overall possibilities of better care for those living in the country. Thus, this acts as a clear indication that these two pillars have a direct link considering that one pillar acts as a determinant of whether the other pillar increases or reduces. In that view, it would be argued that increased expenditure by the United States government towards health care has a direct link towards ensuring that the quality of health services offered increases significantly. Increased government expenditure on health care results in a situation where health facilities find themselves better equipped to offer a wide variety of health services depending on their patients’ needs and expectations.
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On the other hand, increased government expenditure, within the healthcare sector, acts as a direct link towards ensuring that health facilities have an adequate number of health professionals to enhance health services. One of the critical aspects to consider when defining whether the quality of health services offered matches set out expectations is establishing the nurse to patient ratio. In the United States, the federal government has been working hard towards reducing this ratio as a way of ensuring that one nurse handles a lesser number of patients at any given period (Hussey, Wertheimer, & Mehrotra, 2013). That does not only help in reducing the workload for the nurses but also helps towards ensuring that nurses provide better care for their patients regardless of their medical issues. Ultimately, this results in a situation where the quality of health services offered tends to increase significantly as a result of massive investment from the federal government.
Another critical aspect, associated with the United States health care system, which highlights the significant relationship between the pillars of cost and quality is the government’s structured approach towards ensuring that every individual is in a position to access health care. One of the critical challenges that health care systems around the world encounter as part of their approach towards improving health outcomes is reduced access to health services. However, in the United States, the government, through the Department of Health and Human Services, has been on the forefront towards ensuring that more people can access health services. The government's efforts towards improving access to health care do not only reflect on the need for quality improvement measures but suggest that the government is ready and willing to invest more in the sector. In that view, one would argue that the pillar of cost paves the way for quality improvements that would seek to create effective mechanisms for increased demand for health services in the country.
Patient Protection and Affordable Care Act (PPACA)
The signing into law of the Patient Protection and Affordable Care Act (PPACA), commonly referred to as Affordable Care Act (ACA), in 2010 paved the way for significant reductions in costs of health care, as well as, notable improvements in quality outcomes. In other words, the law seeks to create a context for reforms in the United States health care system that would be of value towards improving overall outcomes regarding cost and quality measures. The law sought to create specific provisions that would guarantee health care cost reduction for a majority of the residents in the United States.
In the area of cost, the implementation of PPACA sought to create provisions from which more people would be in a position to access health insurance as part of the key strategies for reducing health care costs. Adkinson & Chung (2014) argue that one of the critical issues facing the United States health system, before the implementation of PPACA, revolved around a situation where approximately 30% of the population lacked any form of medical insurance. Thus, this meant that this population would face significant challenges in access to health care considering that some of the people would not afford the increasing costs. The implementation of PPACA led to the formation of Medicare and Medicaid, which are the two primary forms of medical insurance targeting the population that lacked any form of medical insurance.
The introduction of Medicare meant that any individual above 64 years would be able to access healthcare insurance, which would have a direct impact towards reducing the amount of money that one would spend on health care. Medicare targeted a population of approximately 50 million elder people that had been excluded in other health insurance structures attributed to a vast array of risk factors. On the other hand, Medicaid sought to focus more on the low-income earning population in the country that did not afford private medical insurance, thus, translating to inability to afford health services. The critical idea associated with this particular insurance is that it creates a flexible avenue from which low-income earning families can afford medical insurance. Consequently, this acts as a guarantee that these families would be better positioned to access quality health care services depending on their individual needs and expectations.
In the area of quality, the adoption and implementation of PPACA have played a key role towards improving the quality of health services within the United States health care system. PPACA creates provisions from which healthcare service providers, who include doctors and hospitals, to coordinate in their bid to ensure that they promote quality and prevention as the two critical aspects of health care reforms. PPACA creates new entities referred to as accountable care organizations that would hold each of the healthcare service providers to account for issues of quality associated with the services offered (Rosenbaum, 2011). Ultimately, this meant that majority of the healthcare facilities had to come up with relevant structures that would ensure that they conform to the set-out expectations as per the provisions of PPACA. In the long-term, this had a significant impact towards increasing quality outcomes for the country’s health care system as part of its intentions towards promoting better outcomes.
Success of PPACA in Reducing Costs and Improving Quality
When conducting thorough research on Patient Protection and Affordable Care Act (PPACA), one would note that the implementation of the law has encountered a wide array of barriers some of which have created challenges in the achievement of success. However, one must also note the fact that United States federal government has been on the forefront towards dealing with most of the issues or barriers arising about the adoption of this law. According to Islam, Nadkarni, Zahn, Skillman, Kwon, & Trinh-Shevrin (2015), the United States government showed its commitment in ensuring that the implementation of the act achieves its intended outcomes, which were to reduce costs of healthcare and improve quality measures.
The primary success measure associated with the implementation of PPACA revolves around the fact that the uptake of Medicare and Medicaid has been higher than initial government expectations. The level of response from the populations towards these two medical insurance schemes would be considered as being very useful considering that more people have been able to get medical insurance. Ultimately, this has helped towards ensuring that more people are in better positions allowing them to access quality medical care services within different medical facilities in the country. On the other hand, improvements in health care service provision structures, in a majority of health facilities in the country, also acts as one of the critical aspects that highlights the success associated with PPACA. Currently, the quality of medical services offered a majority of health facilities in the country is significantly higher when compared to the services offered before the adoption and implementation of PPACA.
References
Adkinson, J. M., & Chung, K. C. (2014). The Patient Protection and Affordable Care Act. Hand clinics , 30 (3), 345-352.
Burke, L. A., & Ryan, A. M. (2014). The complicated relationship between cost and quality in US health care. Virtual Mentor , 16 (2), 124-136.
Hussey, P. S., Wertheimer, S., & Mehrotra, A. (2013). The Association between Health Care Quality and Cost: A Systematic Review. Annals of Internal Medicine , 158 (1), 27-34.
Islam, N., Nadkarni, S. K., Zahn, D., Skillman, M., Kwon, S. C., & Trinh-Shevrin, C. (2015). Integrating community health workers within Patient Protection and Affordable Care Act implementation. Journal of public health management and practice: JPHMP , 21 (1), 42-68.
Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: implications for public health policy and practice. Public health reports , 126 (1), 130-135.
