Iron Triangle: A Health Policy Analysis

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Health policy analyst have long discussed and debated the commonly referred to “Iron Triangle” of health care. This term is used to describe the relationship between access, cost, and quality; emphasizing that no one part of the triangle can be altered without affecting the other two. The relationship between each is reciprocal and at the same time competitive. Therefore, making it extremely difficult to have any positive and significant change in access, cost or quality. If you increase access to health care, you then increase cost and possibly decrease quality of care. If you increase the quality you are likely to increase the cost and then decrease access (Health Informatics, 2015). Dr. Aaron Carroll (2012) believes there are always…show more content…
Carroll (2011) recalls a previous medical school professor Dr. William Kissick who noted that these tradeoffs between access, cost, and quality are not always required. Carroll (2011) citing Kissick’s belief that “tying payments to health care providers to the quality of services provided could improve providers’ incentives to contain costs and improve quality.” Kissick also stated that “better quality could also be achieved at less cost by reducing unnecessary services and managing consumers with chronic conditions more cost-effectively. Through the review of many articles on the “Iron Triangle” effect I can honestly say that it seems to be common sense. When the factors of access, cost and quality are all tied together, and viewed as synergistic, it is only reasonable that a change in one would affect the other two. The real question is does attempting a positive change in one always have to lead to a negative change in another? Dr. Liu (2012) points out in his article: The Iron Triangle of Health Care is Not Law but an Observation, that when the status quo was disrupted in the areas of aviation and computing, both services and goods became more accessible, affordable and of higher quality. There was at one time a reality that air travel was extremely expensive and available to only a few. Few people in the sixties and seventies…show more content…
It gives me encouragement and hope by its example. However, it must be noted that it took competition and the market based economy to help us get there in the examples cited above. Therefore, they are not apples to apples comparisons. Dr. Donald Berwick’s (2011) article titled, “We can have it all,” states that we can achieve for all patients, “…better care, better health and lower costs-all at the same time.” He identifies the three variables of the “Iron Triangle” of healthcare…cost, quality and access. He states that through the Affordable Care Act America has addressed the access variable of the healthcare triangle. However, he goes on to recognize the need to address the quality and cost variables as well. The question is how to afford this new increased access while not only maintaining but improving quality of care. Dr. Berwick believes a paradigm shift in the delivery of healthcare, instituted by an accountable care organization (ACO) would allow for improved quality of care and lower costs within the healthcare system. An ACO is a network of doctors and hospitals that shares responsibility for providing care to patients. Gold (2011) states that according to the recently passed Affordable Healthcare Act, an ACO would be structured to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three
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