The current relationship between cost, quality, and access in healthcare can be summarized by adapting a familiar software development adage: Cost, quality, and access: pick any two. In the book Healthcare USA: Understanding Its Organization and Delivery, Harry Sultz and Kristina Young state, “It is obvious that these goals are contradictory and that attainment of any two leaves the third uncontrolled.”

Quality refers to the relationship between interventions and outcomes, and the degree to which interventions achieve the desired effect (return to well state, reduction in symptoms, prolonged life, or comfort at end of life, among others). Cost refers to the financial burden of care to all interested parties: patients, providers, government, employers, and insurers. Access refers to the availability of care to those who need it.

Attempts to address each of these aspects of healthcare since then 1960s have not resulted in a balance between the three. Medicare and Medicaid were created to provide healthcare for all, but costs escalated as a result. Cost containment then became the priority. With the advent of managed care, costs should have been maintained in theory, but so far this has not been the case. According to Sultz and Young, with “the primary goal of the market [being] contain[ment of] costs,” access suffers.

Managed care was also designed to ensure quality by monitoring patterns of treatment and outcomes “to identify deviations from quality and efficiency standards.” Quality metrics involve number and kinds of tests ordered and procedures conducted, outcomes from these interventions, and number of errors that occur in medical care. The current healthcare philosophy in the United States values “heroic medicine” over preventive care. This was brought on by an insurance system that rewards such practices. Providers react to this by conducting more tests and performing more procedures than those in other countries because they are rewarded financially. However, costs continue to rise while quality does not.

If technology used to increase the number and kinds of tests and procedures that are administered doesn’t result in quality improvement, and access to these interventions is not equitable, perhaps then technology could be more effectively used to improve preventive care and involve patients in their treatment. Preventive care is “far less costly” and “results in measurable economic and human benefits.”

 Examples of technology used for preventive care range from health information delivered via the Internet to wearable medical devices designed to alert caregivers of potential problems with elderly patients before they arise. To use the example of prenatal care from the text, technology could be used to provide remote access to classes about prenatal care to patients who don’t have transportation or time to attend a class in person, with supplemental information delivered via email, SMS, or social media.

Changing the prevailing attitude of patients that they are not solely responsible for being sick, and that they are also not responsible for getting themselves well is a radical cultural shift that technology alone cannot achieve. However, technology can break down some of the barriers to access and provide relatively low-cost preventive care. In addition, changing the current philosophy of healthcare to value these kinds of approaches means a cultural shift, which will not occur until financial rewards exist for these types of interventions. 

Lee Farabaugh
Director of User Experience