The Importance and Cost of Quality Healthcare

Abstract

The main purpose of this study is to explore the different dimensions of healthcare and

how each other affects the quality provided by the system. Dimensions were: effectiveness,

efficiency, accessibility, patient centered care, equity and safety. This study also covers how the

change in perspective affects the quality of care. Unlike in the traditional ways where physicians

decide on the quality of care. Today patients are involved in the assessment process. Also, to

minimize bias on judgment studies and experts provided for implicit and explicit standards of

assessment. To address the ever-changing needs of healthcare system, the government thru the

public policy makers tries to answer the call on a better system to improve the current health care

scheme to address accessibility, quality and cost.

 The Importance and Cost of Quality Healthcare

Quality is a human right rather than a privilege. The system today addresses the need to

provide for quality healthcare to the citizens. The paper aims to analyze the dimensions involved

in the rendition of quality of care and the standards set to assess it. Also the actions of the

government to address the current dilemma of the healthcare system.

 Assessing Aspects of Quality of Care

Today, quality is a major aspect in every person’s lives. Continuously each individual

search for quality services and products (Mosadeghrad, 2012). The same can be said as to

healthcare, every person yearns for a quality healthcare to be provided because this is a human

right rather than a privilege (Fongwa, 1998). Higher quality of healthcare leads to improved

satisfaction of the patients and the public, the institution or organization, and the employees

(Mosadeghrad, 2012). Studies shows the results of improved health care quality like decreased

cost, increased productivity, availability of better services, enhanced performance of the

organization and improved working relationships for employees and the institution

(Mosadeghrad, 2012).

Quality being subjective and intangible in nature makes it difficult to define. Unlike other

industries healthcare quality is even more harder to define and measure (Mosadeghrad, 2012).

This difficulty is also attributed to different factor like the complexity of the practice and the vast

number of participants with varying interests in the delivery of care and ethical consideration

(Mosadeghrad, 2012).

Several authorities defined healthcare quality. According to Leebov healthcare quality is

“doing the right things right and making continuous improvements, obtaining the best possible

clinical outcome, satisfying all customers, retaining talented staff and maintaining sound

financial performance” (Mosadeghrad, 2012).

Quality of care is multifaceted and involves several aspects. In the paper released by the

World Health Organization (WHO) in 2006 the following were cited as the six dimensions that

needs improvement in rendering quality care:

  effective, rendition of health care that is based on empirical data or evidence-based

practice;

 efficient, maximizing resource use of resources to avoid wastage;

 accessible, delivery of care in a manner that is timely, geographically reasonable, parallel

use of skills in settings in need of medical care;

 patient centered or acceptable, providing health care that focuses in the preferences and

needs of individual patients and care that is culture sensitive;

 equitable, care that does not vary depending on the personal circumstance of the patient

such as geographical location, socio-economic status, race or gender;

 safe, care that limits harm and risk to the patients and providers.

The above-mentioned dimensions are important and none can stand alone in maintaining

the rendition of quality care. Each play like a link in a chain, weakness or absence of one can

affect healthcare as a whole.

Unlike in the olden times where quality I only measured by the opinion of the physicians,

nowadays patients themselves are involved in assessing the care provided. Patients now place a

larger emphasis on the effectivity of services, easy access to skilled and experienced providers,

health inducive milieu of care, facilities and equipment (Mosadeghrad, 2012). For patients, one

of the most important aspect of care are having their medical needs addressed and resolve, the

accessibility of competent, skilled, caring and supportive providers who shows true concern

about their needs, providers who listens and protect their privacy, providers who collaborates and

involves the patient and other family member in the treatment process and meet the patients

values and expectations (Mosadeghrad, 2012).

 Improving United States Healthcare: Government’s Answer to the Need

The government and its legislative branch have been in a continuing struggle to control

the rapid increase of healthcare cost while aiming to provide opportunities for every citizen to

have healthier lives. Despite of the efforts healthcare spending in the country continuously

exceeds economic growth and at an unsustainable pace (American College of Physicians, 2009).

One way to address this needs the Affordable Care Act was enacted. Despite of the

multiple issues thrown against this legislation the provisions of the law aims to provide access to

quality healthcare to Americans while limiting healthcare cost (American College of Physicians,

2009).

One of the provisions of the said law addresses the cost of having insurance coverage,

Section 1413 of the Act mandates the Secretary in general to streamline procedures for

enrollment through an exchange and state Medicaid, chip, and health subsidy programs. Under

the same provision of ACA, states are required to develop secure interfaces to allow exchange of

data electronically and to help match data among the citizens and the applicable subsidy to the

individuals. While employers if small enterprise, Section 9022 of ACA provides for guidelines

on how to qualify in purchasing cheaper insurance for its employees and maintaining law

mandated division of contribution and at the same time a progressive scheme on the premium

payment depending on the status of the employee.

The access to healthcare is now more open to the citizens. However, this does not only

pertain to lowering the cost of insurance premiums but also to those who will be eligible to

purchase insurance products. Under the Act, particularly, Section 1101 Subtitle B and Section

2704 Subtitle B, the former ensures the access to insurance for uninsured individuals with
preexisting condition and the latter imposes prohibition of preexisting condition exclusions or

other discrimination based on health status. These provisions of the law paves way to individuals

who has preexisting diseases to purchase insurance and gain access to healthcare without paying

higher premiums or being denied in buying insurance.

Children will also be covered longer. Section 2274 extends dependent coverage of

children until they turn 26. Also, under the same Act, Subtitle B, “Increasing Access to Clinical

Preventive Services”, the provisions recommend preventive care must be covered by insurance.

Jones 2013 stated, in order to shift cost from so called “rescue care,” which results from delayed

access to care or treatment, insurance is required to cover for preventive care. This scheme

addresses the issue of higher cost when care is delayed and patients are sicker.

One of the salient provisions of ACA is mandating insurers to use 85% percent of the

insurance premiums to medical care otherwise, patients gets rebate. Finally, insurance companies

must keep overhead expenses to a minimum and use bulk of the insured premium dollars for

providing health care or they must refund the premium dollars to the insured. By following this

scheme, on the first year of this requirement, this provision was estimated to have saved

consumers approximately $1.5 billion (Elaine C. Jones, 2013)

Finally, the issue of rendering quality health care the ACA created three particular

programs; 1.) The Hospital Acquired Condition Reduction Program (HACRP) 2.) Hospital

Readmission Reduction Program and (HRRP) 3.) Medicare Hospital Value Based Purchasing

Program (HVBP).

According to Beezley-Smith (2017) in her study entitled Pay-for-Performance in

Medicare, Section 3008 of the Act established HACRP where hospitals in this program are
evaluated. The Secretary of the Department of Health and Human Service must adjust payments

to applicable hospitals that rank worst-performing quartile of all subsection (d) hospitals with

respect to risk-adjusted HAC quality measures.

In the same study, HRRP which was established under Section 3025 of ACA requires the

Secretary of the Department of Health and Human Services to establish a Hospital Readmissions

Reduction Program whereby the Secretary reduces Inpatient Prospective Payment System (IPPS)

payments to hospitals for excess readmissions beginning on or after October 1, 2012.

Lastly, Hospital Value-Based Purchasing (VBP) Program, applied under Medicare’s

inpatient prospective payment system (IPPS), adjusts payments to hospitals based on CMS

measures of quality of care furnished to patients. Starting in October 2012, with payment

adjustments beginning in fiscal year 2013, the program “affects payment for inpatient stays in

more than 3,000 hospitals across the country.” Medicare makes incentive payments to hospitals

based on either how well they perform on each measure or how much they improve their

performance on each measure compared to their performance during a baseline period.

All three programs aim to incentivize hospitals which performs better in providing care to

its patients.

Healthcare Assessment: Analyzing Criteria

In assessing healthcare quality several studies made used of two standards; explicit

normative and implicit judgment.

Explicit standards for assessing quality of care developed and established for advance

assessment of quality healthcare. The purpose of this type of the criteria is to minimize variation

and bias from internal judgment (Donabedian , 1981). In formulating these criteria inspires an in
depth critical scrutiny of the practice. But one must be mindful that this is a double-edged sword

as a vehicle to promote best practice that can be offered and institutionalize and pervasive error

(Donabedian , 1981). Thus, it must be noted to know who has control over the criteria, the

perspective involved and the interest that it serves. On the other hand, implicit standards, rely

more on internalized judgement of experts (Young & Sultz, 2018).

Harmonization of both criteria is important to minimized bias in assessment of quality

care. Whatever gap provided for by one will be addressed by the other.
References

American College of Physicians. (2009). American College of Physicians. Controlling Health

Care Costs While Promoting The Best. American College of Physicians Policy

Monograph.

Dana Beezley-Smith, P. (2018, 06 14). Pay-for-Performance in Medicare. Retrieved from U.S.

Health Policy Gateway: http://ushealthpolicygateway.com/payer-trade-

groups/qualitysatisfaction/quality-improvement/general-approaches/pay-for-

performance/pay-for-performance-in-medicare/#Hospital_Value-

Based_Purchasing_Program_HVBP

Donabedian , A. (1981). Advantages and limitations of explicit criteria for assessing the quality

of health care. Milbank Mem Fund Q Health Society.

Elaine C. Jones, M. F. (2013). Supreme Court decision on the Affordable Care Act. Neurol Clin

Pract, 61-66.

Fongwa, M. (1998). Dimensions of Quality of Care: African Americans' Perspective. Graduate

Division University of California, 1-287.

Mosadeghrad, A. (2012). A Conceptual Framework for Quality of Care. Mat Soc Med., 251-261.

World Health Organization. (2006). Quality of Care: A Process for Making Strategic Choices in

Health Systems. Geneva, Switzerland: World Health Organization Press.

Young, K. M., & Sultz, H. A. (2018). Health care USA : understanding its organization and

delivery 9th Edition. Burlington, MA: Jones & Bartlett Learning.