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Cost, Quality, and Access in the U.S. Healthcare Delivery System

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1) Analyze at least two barriers in the U.S. health care delivery system related to cost, quality, and/or access that are evident in each person's scenario.

2) Analyze how health insurance may influence concerns or decisions related to cost, quality, and/or access to health care for each person.

3) Explain potential health care outcomes for each scenario.

Consider the following example:
According to a 2013 article in Kaiser Health News, Gallup Indian Medical Center in New Mexico, a busy federal government hospital on the border of the Navajo Reservation that sees a complex population of patients, learned it would be paid 1.14 percent less for each Medicare patient as a penalty for poor quality scores. Those who gained financially from the Medicare reimbursement policy change included large teaching hospitals and specialty hospitals. For instance, a physician-owned hospital focused on cardiovascular care in Arkansas received one of the largest bonuses (Rau, 2014).

This example highlights some of the complexities surrounding cost, quality, and access that health care administrators frequently encounter. Identify a specific example related to health care, economics, policy, or other pertinent topics that is presented in credible sources. Analyze your selected example and consider how it illustrates concerns related to cost, quality, and/or access. Also consider potential implications of this issue for the management and leadership of health services organizations.
Post a substantive and cohesive response to the following:

1) Provide a description of the example you selected.

2) Analyze how this example illustrates concerns related to cost, quality, and/or access to health care.

3)Evaluate one or more potential implications of the issue(s) described in your example for the management and leadership of health services organizations.

Readings
Shi, L., & Singh, D. (2015). Delivering health care in America: A systems approach (6th ed.). Burlington, MA: Jones & Bartlett.
Chapter 12, "Cost, Access, and Quality" (pp. 464-500)

Select and read three or more of the following resources to support your Discussion postings.

Institute of Medicine. (2014). Dying in America: Improving quality and honoring individual preferences near the end of life: Key findings and recommendations. Retrieved from http://www.iom.edu/%7E/media/Files/Report%20Files/2014/EOL/Key%20Findings%20and%20Recommendations.pdf

National Academy of Sciences (2014). Dying in America: Improving quality and honoring individual preferences near the end of life: Key findings and recommendations. Retrieved from http://www.iom.edu/%7E/media/Files/Report%20Files/2014/EOL/Key%20Findings%20and%20Recommendations.pdf

Centers for Disease Control and Prevention. (2014). Healthy living. Retrieved from http://www.cdc.gov/HealthyLiving

Gold, J. (2014). FAQ on ACOs: Accountable Care Organizations, explained. Retrieved from http://kaiserhealthnews.org/news/aco-accountable-care-organization-faq/

Jenny Gold, Kaiser Health News, http://kaiserhealthnews.org/news/aco-accountable-care-organization-faq/

HealthCare.gov. (2014). Type of plan and provider network. Retrieved from https://www.healthcare.gov/choose-a-plan/plan-types/

HealthyPeople.gov. (2014). Foundation health measures. Retrieved from http://www.healthypeople.gov/2020/about/tracking.aspx

Levi, J., Segal, L. M., Fuchs Miller, A., & Lang, A. (2013). A healthier America 2013: Strategies to move from sick care to health care in the next four years. Retrieved from http://www.kresge.org/sites/default/files/Trust-for-Americas-Health.pdf

Medicare.gov. (2014). Linking quality to payment. Retrieved from http://www.medicare.gov/hospitalcompare/linking-quality-to-payment.html?AspxAutoDetectCookieSupport=1

National Institute of Standards and Technology. (2014). Four U.S. organizations honored with 2014 Baldrige National Quality Award. Retrieved from http://www.nist.gov/baldrige/baldrige-award-111214.cfm

Note: Click on the links provided to view information about each of the award recipients and compare quality-promotion strategies used in multiple sectors (i.e., service, nonprofit, health care).

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Solution Preview

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415172/

Cost, Quality, and Access in the U.S. Healthcare Delivery System

1) Analyze at least two barriers in the U.S. health care delivery system related to cost, quality, and/or access that are evident in each person's scenario.

The two biggest barriers to reforming the healthcare system in regard to delivery of care, costs, and quality of care are the current fee-for-service payment system and the lack of coordination between healthcare providers that jeopardizes patient care in America.

2) Analyze how health insurance may influence concerns or decisions related to cost, quality, and/or access to health care for each person.

Health insurance influences the cost, quality and access to care as the ACA has provided healthcare consumers with greater healthcare insurance options, technology has given consumers the ability to become more informed and involved in their healthcare decision-making, and the new focus on quality has required healthcare providers and insurers to treat consumers with respect and dignity.

3) Explain potential health care outcomes for each scenario.

Potential outcomes are that because patients will be spending more out-of-pocket expenses for medication, insurers and healthcare providers will have to ensure that they provide cheaper prices ...

Solution Summary

The expert analyzes two barriers in the United States health care delivery system as it relates to costs, quality and access that is evident in each person's scenarios. How health insurance may influence concerns are given.

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