Introduction
The cost of healthcare has been on the rise in the recent past. The situation persists in spite of the programs and policies put in place by the government to manage the problem. Experts predict that the trend will continue if steps are not taken to change things (Canning, 2013). In this paper, the author looks at ways of managing costs without reducing access to healthcare. In addition, the proposed strategies are structured to ensure that the quality of services is not compromised. Finally, the recommendations should not cause undue burdens to healthcare providers.
Role of Private and Public Agencies in Addressing Cost and Quality in Healthcare
Public Agency
Health agencies are mainly responsible for the implementation of health programs (Bodenheimer, 2005). An example is Healthcare Research and Quality (AHRQ). It is a public agency under the Department of Health and Human Services. It is mainly tasked with the responsibility of supporting research designed to improve the quality of healthcare. The research is also aimed at reducing costs, improving patient safety, decreasing medical errors, and increasing access to essential services (Bodenheimer, 2005). AHRQ addresses cost and quality by sponsoring and conducting studies that provide evidence-based information on how to reduce costs while upholding or improving standards. For instance, one of its studies established that there are low-cost drugs that can provide patients with a quality of care that is similar to that provided by expensive therapies. In addition, the agency has identified conditions for which drug therapy is not necessary (Bodenheimer, 2005). Such findings have helped caregivers to reduce costs without compromising on quality. It is an indication that studies supported by AHRQ can help practitioners determine interventions that can reduce medical expenses without impacting negatively the quality of care.
Private Agency
Some private agencies also play an important role in reducing costs associated with healthcare. Insurance companies, which are examples of private agencies, aimed at lowering costs by focusing on primary care and preventive services that decrease unnecessary hospital treatments, readmission rates, and days spent in hospitals (Fottler, Ford & Heaton, 2002). The companies create a link between health institutions and caregivers. The aim is to enhance continuity and keep track of the recovery made by patients (Fottler et al., 2002). Such practices improve the quality of healthcare and reduce the costs incurred
Initiatives Aimed at Improving Quality while Reducing Costs at the Same Time
Today, governments and other stakeholders have initiated a number of programs at different levels of the healthcare system to reduce costs and improve the quality of services rendered. The first involves the introduction of bundled payment systems for hospital and clinical services. There are also pay-for-performance incentives for physicians. Such interventions have reduced healthcare costs by over 1.5% without affecting quality (Alrashdan, Momani & Ababneh, 2011). Measures that avoid duplicative and inappropriate services have also been put in place. Readmission rates have reduced as a result of the implementation of evidence-based protocols that reduce excessive testing and imaging (Canning, 2013).
Other significant steps include preventing and rehabilitating diseases to control their spread. The move reduces the chances of resultant costly treatments (Barker & DeNisco, 2012). Other initiatives that are yet to be implemented encourage patients to interact with doctors via mail and other platforms as opposed to making appointments. As such, doctors will have more time to provide quality care (Yong, Olsen & McGinnis, 2010). Electronic medical records are also expected to greatly reduce administrative costs.
Unintended Consequences
At times, some of the measures taken to improve quality and reduce costs have unintended consequences. For instance, reducing the number of tests carried out on patients may lead to late detection of illnesses and misdiagnoses (Makadon, Bharucha, Gavin, Oliveira & Wietecha, 2010). It is a fact that duplicative services are a major source of inefficiencies. However, at times, they are needed to save a life, especially in healthcare.
Other unintended consequences may be in the form of additional and unaccounted for expenses, which include training costs and expenses incurred in human resource and information management (Makadon et al., 2010). Measures to improve quality are meant to decrease disparities in the provision of healthcare services. However, in some cases, they have led to inequalities.
Implications
Initiatives intended to improve quality and manage costs of healthcare have major impacts on nursing and evidence-based practice. For instance, some people argue that the population of nurses should be reduced to lower costs. However, others hold that the population should be increased to improve the quality of healthcare services (Bodenheimer, 2005). Evidence-based practice is also largely affected. It is mainly because quality improvement programs measure processes of care as opposed to outcomes. As such, innovations arising from evidence-based practices are hindered.
Conclusion
It is important to manage cost and quality in healthcare. Such a move helps in the provision of affordable services. Different agencies have made efforts to achieve these objectives. The measures put in place by these stakeholders have significant impacts on the quality and cost of healthcare services.
References
Alrashdan, A., Momani, A., & Ababneh, T. (2011). Activities identification for activity-based cost/management applications of the diagnostics outpatient procedures. Journal for Healthcare Quality, 34(1), 35-43.
Barker, A., & DeNisco, S. (2012). Advanced practice nursing: Evolving roles for the transformation of the profession (2nd ed.). Boston: Jones & Bartlett
Bodenheimer, T. (2005). High and rising health care costs part 4: Can costs be controlled while preserving quality?. Annals of Internal Medicine, 143(1), 26.
Canning, D. (2013). Axiomatic foundations for cost-effectiveness analysis. Health Economics, 22(12), 1405-1416.
Fottler, M., Ford, R., & Heaton, C. (2002). Achieving service excellence. Chicago, IL: Health Administration Press.
Makadon, H., Bharucha, F., Gavin, M., Oliveira, J., & Wietecha, M. (2010). Value management: Optimizing quality, service, and cost. Journal for Healthcare Quality, 32(1), 29-34.
Yong, P., Olsen, L., & McGinnis, J. (2010). Value in health care. Washington, D.C.: National Academies Press.