Cost, Quality, and Access in the Health Care System

Author(s): Ahmadi, R. H.; Asthana, R. | Abstract: The American health care system is beset by significant problems. Chief among these are the continuing rapid growth in costs, and denial of access to a large portion of the population. Amidst the problems, however, remains the fact that the U.S. system offers a very high quality of care to those with access. To address the problems in the health care system, yet preserve quality standard, a considerable number of reform proposals have been advanced. The problem of providing universal access without decreasing quality or increasing cost, however, remains challenging.In this paper, we demonstrate a methodology that, for a single disease of specific characteristics and within modeling assumptions, shows that it is possible to achieve universal access and increase service quality without increasing cost. The central tenet of the methodology is to relate quantitatively the three dimensions of cost, quality, and access. Understanding the quantitative relationships among cost, quality, and access allows for the testing of policies by measuring the impact (positive or negative) of a change in one dimension on the other two dimensions. The methodology is developed as follows: We define two measures of quality. First, 'national health quality,' or NHQ, that defines the quality of health of the population and, second, service quality, or SQ, at medical treatment facilities. We use queueing systems in steady state to model the relationships between each measure of quality with cost and access.The relationships among cost, quality, and access serve as the foundation for single disease managerial and policy analysis. In particular, we demonstrate that there are several policies that achieve, at constant cost, universal access and increase in quality. The relationships developed in the paper allow for the selection of the supremum policy.