Lindsey Crawford CHEP #2 Reform of Cost, Access and Quality 1

Today many Americans are unhappy with the current health care system in the U.S, yet at

the same time they are relatively content with their own health care plan. Due to disagreement in

these views and the general public’s skepticism of the U.S. government, there’s a large breach in

the general public’s support for what should be done about the complications facing the U.S.

health care system and the support for policies to achieve these objectives (Blendon et al., 2006).

Cost, access and quality in the health care delivery system today is an issue that needs to be

reformed. Over the years, employers and third-party payers in the U.S have been concerned with

trying to control the development of health care spending (Shi & Singh, 2013, p. 281). Since

President Bill Clintons reform proposal failed, the rate of un-insured patients have risen and

health care spending has made up an increased portion of the American budget (Blendon et al.,

2006). I personally take all three of these things into consideration when trying to choose my

health care plan. I want to ensure that I am able to get the best price as well as great access and

quality of health care my family needs.

Cost, access and quality would be considered the iron triangle for health care delivery.

When one component of the iron triangle is affected, it is very difficult for it not to impact the

other two components as well (Jacobs, 2014). Cost is how much money people are willing to

spend on health care (Jacobs, 2014). Access is being able to obtain required, inexpensive,

favorable, suitable and successful health care services in a timely manner (Shi & Singh, 2013,

p.294). Quality is the satisfaction of the product to the customer (Jacobs, 2014). In most cases

you need to increase the cost of health care in order to increase the quality of care (Jacobs, 2014).

Rising health care prices are what is causing anxiety in the public causing them to think

they are going to be unable to afford health care services in the future (Blendon et al., 2006).

Even though the public can be worried about the rising cost of health care, it is the price
Lindsey Crawford CHEP #2 Reform of Cost, Access and Quality 2

increases of health care services and medicines that worry them more (Blendon et al., 2006).

With the inflation in the economy and lower wages, it makes it difficult for most Americans to

afford high health insurance premiums, deductibles and copays. For example, if an employee

only makes $1500 a month after taxes and has monthly living expenses of $1300, then the

employee could not afford a health care plan that’s $300 a month with copays of $30 each visit.

When health care cost rise, Americans have to give up other goods and services when more is

spent on health care (Shi & Singh, 2013, p.291).

There are financial and non-financial barriers to access health care (Jacobs, 2014).

Financial barriers to access health care that most Americans face are low income and no health

insurance coverage. Individuals that struggle with obtaining health care tend to be indigent, less

educated or employed in an environment that can cause greater wellness risk (Shi & Singh, 2013,

p.299). Access to health care is a key determinate in health status along with other factors such

as the environment, lifestyle and heredity factors (Shi & Singh, 2013, p.294). Due to lack of

access to care 25,000-50,000 people die annually (Jacobs, 2014).

At this time most of the general public are content with the quality of medical care they

obtain, but they do worry that in the future they may be a victim of a medical error (Blendon et

al., 2006). Americans tend to say that the causes of medical errors are heavy workloads,

ineffective staffing and poor conveyance among healthcare providers (Blendon et al., 2006).

Most Americans think that information from healthcare providers about quality of care should be

something that is required by law (Blendon et al., 2006). Some examples of high quality care are:

good access to care, competent healthcare providers and scientist knowledge (Jacobs, 2014).

Structure, process and outcomes are three domains in which quality health care should be
Lindsey Crawford CHEP #2 Reform of Cost, Access and Quality 3

examined (Shi & Singh, 2013, p.302). All three of these domains go hand in hand although good

structure is the foundation of quality health care.

The Affordable Care Act for employers mandates that all employers that have fifty or

more full time employees are required to offer health insurance coverage to those employees or

the employer can face financial penalties (Cowley, 2015). Although the Affordable Care Act has

decreased the number of people without health insurance coverage there are still a large number

of low-wage workers that are falling through the gaps (Cowley, 2015). With this being said

increasing cost, lack in access and concerns about quality are the biggest challenges the health

care delivery system faces in the U.S (Shi & Singh, 2013, p.307). Government spending on

health care has grown rapidly and in order for the cost to decrease, access to care will need to

increase (Jacobs, 2014). With this being said I believe that if the cost of health care decreased

slightly but access to good quality health care was still available to those with lower incomes,

our health care delivery system would improve significantly.
Lindsey Crawford CHEP #2 Reform of Cost, Access and Quality 4


Jacobs, V. (December 4, 2014). Access, Quality, Cost in Healthcare. Retrieved from:

Shi, L., & Singh, D. (2013). Essentials of the US Health Care System (3rd Ed.). Burlington, MA:

Jones and Bartlett.

Cowley. S. (October 19, 2015). Many Low-Income Workers Say No to Health Insurance.

Retrieved from:

Blendon et al. (2006). Americans’ Views of Health Care Costs, Access, and Quality. Milbank

Quarterly. Vol. 84 Issue 4, p623-657.