Supporting the Concept of the Iron Triangle of Healthcare for patients, government, and healthcare providers

Supporting the Concept of the Iron Triangle of Healthcare for patients, government, and healthcare providers
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December 8, 2020
Supporting the Concept of the Iron Triangle of Healthcare for patients, government, and healthcare providers
The “Iron Triangle” of health, as introduced by William Kissick in 1994, postulates that its fundamental components comprising access, cost, and quality cannot be enhanced simultaneously. The proposition is based on the observations that an improvement in one component of the iron triangle causes a decline of at least one of the other two. There has been simmering talk about healthcare as a system comprised of various components. The iron triangle of health reflects one of the approaches to understanding the healthcare system. The three fundamental elements that make up the iron triangle of health include access, cost, and quality. These three core items constitute the centrality of focus for the government, patients, and healthcare providers. The ideal healthcare system is marked by broad healthcare services accessibility, affordable and friendly costs, and high quality. The idealized situation where costs, quality, and access regarding health services are optimized is arguable utopian and is not alive to contemporary realities. Can the costs, access, and quality be at the highest level of performance at any given time? Can people seamlessly access quality healthcare at affordable costs? Equally, can the government facilitate the provision of quality healthcare services within reasonable costs and friendly budgetary allocation? Do healthcare providers have the capacity to offer quality health services accessible and affordable to the general population? These rhetorical questions illustrate the extent of controversy and contestations surrounding the concept of the iron triangle of health. This paper will argue and demonstrate that the iron triangle of health, as represented by costs, access, and quality, denotes a fierce clash of its core components and that there is a controversy and conflict when there are efforts to fine-tune the three elements.
Over recent times, there is raging discussion permeating public, political and scholarly discourses, with themes of cost, access, and quality, featuring prominently in discussions. The thought-provoking question in these debates revolves around nurturing a healthcare system marked by seamless accessibility, affordable costs, and high quality. Can these aspirations be achieved simultaneously within the overall healthcare system with engagements from the patients, healthcare providers, private sector stakeholders, and government? Or are they just mere fantasies? The contemporary healthcare environment demonstrates otherwise. Arguably, people lack seamless access to quality and affordable healthcare services. With the rising prevalence of chronic diseases, accompanied by coronavirus disease, with associated morbidities and mortality, it is clear that the healthcare system is highly constrained to offer accessible, quality, and affordable services.
More often, poor prognosis and adverse health outcomes constitute a testimony that a significant portion of the population cannot access quality and affordable healthcare services. Even in instances where access is enhanced, quality appears to suffer a setback. Similarly, when quality is optimized, costs tend to increase, leading to diminishing accessibility because more people may not afford costly quality services. Thus, it appears to be more of an inherent trade-off amongst costs, access, and quality where when one or two are improved, and the other suffers the consequences. The improvement of one aspect, such as accessibility, is achieved at the expense of quality. Suppose the healthcare system is made cheaper to allow increased accessibility; it may often lead to indirect or direct quality improvement. If the quality is to be sustained, there might need to increase the budgetary allocation, leading again to increased costs, which is a barrier to healthcare service access. Thus, these elements are in persistent conflict. People such as policymakers and politicians may be in denial or are purely lying when they advance promises and plans, contemplating an idealized healthcare system that is universally accessible, of high-quality standards, and affordable.
The desire to achieved excellent performance in healthcare affordability, accessibility and quality at the same time underpins the prevailing fragile healthcare systems. The current healthcare is marked with escalating healthcare costs, poor accessibility, and arguably low-quality services. The COVID-19, as an example of disease, exposes long-standing healthcare challenges that permeate thought the U.S healthcare system (Chaturvedi & Gabriel, 2020). There are remarkable health disparities, especially amongst the vulnerable and minority populations, despite immense investments and expenditure in addressing healthcare access among these categories of marginalized groups. Several faultlines mark the U.S healthcare system despite massive expenditures on it through the comprehensive health care reform law enacted in 2010, often called the Affordable Care Act (ACA), or “Obamacare”. The ACA reflects one of the ambitions that embody unresolved clashes and controversies between costs, quality, and healthcare services access. The critics of ACA cite increased costs and being overambitious and unrealistic regarding the implementation of this legislation. But this legislation should not be wholly dismissed because it has provided less costly options to patients of financing healthcare services.
The ACA enhanced health insurance coverage for millions of people facing challenging circumstances. For instance, people could access free care services if they met the income criterion that matches Medicaid or federal insurance within online marketplaces. Prior to this ACA, patients with chronic and preexisting conditions such as cancer could not easily find relevant private medical insurance covers. In case they were lucky to get covered, they could encounter difficulties in paying hospital bills or have restricted limits of benefits. The Obamacare plan sought to resolve the element of discrimination so that patients with preexisting illnesses could access health services. However, despite increasing access to healthcare services amongst millions of American citizens, it failed to control rising costs in the form of premiums and deductibles because ACA appeared to have underestimated the core driving factors of premium rate and deductibles, which were often the costs of healthcare care services and prescription drugs. Overall, the contestations and conflicting inclinations surrounding intricate and interconnected relationships between healthcare access, affordability...