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Class: Health Economics I will need two separate responses for the following Posts. 150 words with 1 source per post. Thank you First Post: Experts in health policy use a term known as the “iron triangle of healthcare” which includes access, cost, and quality (Carroll, 2012). According to this model, it is possible to improve one or maybe two of these areas of healthcare, but that requires a trade-off in the other areas of the triangle (Carroll, 2012). For example, to improve access to healthcare, the quality may have to decrease, or the cost may have to rise. On the other hand, to improve the quality of care, the cost may have to rise or the access to care may need to be limited. These are difficult trade-offs for policy makers to decide between. Politicians tend to promise all three when it comes to healthcare reform, low cost, high quality, and access to care for everyone, but they fail to acknowledge the economic impossibilities of such a promise (Carroll, 2012). To provide both high quality healthcare and increased access to healthcare, the cost of healthcare would need to increase substantially (Carroll, 2012). A real-world example of this was the Affordable Care Act, which increased access to healthcare for Americans but also increased the cost of care (Carroll, 2012). By guaranteeing access to health insurance for anyone with preexisting conditions and preventing these individuals from being charged higher premiums, and funding government subsidies so that everyone could purchase insurance, access to healthcare was improved but there was an increase in cost to individuals and the government (Carroll, 2012). The Affordable Care Act did not seem to actually improve the quality of healthcare (Manchikanti, Helm, Benyamin, & Hirsch, 2017). In an effort to improve the quality of care, the ACA created many new agencies and commissions which increased the cost of regulatory compliance and caused the number of small independent practices to decrease (Manchikanti et al., 2017). In addition, despite the goal of improving healthcare quality by focusing more on prevention, only 3% of health care expenditures were spent on preventative services (Manchikanti et al., 2017). Trade-offs in healthcare are a harsh economic reality, and to create better policies, we have to stop pretending that we can have it all. It would be more effective to be open about possible trade-offs and decide which things we value most. References: Carroll, A., MD. (2012, October 03). The “Iron Triangle” of health Care: Access, cost, and quality. Retrieved February 27, 2021, from https://jamanetwork.com/channels/health-forum/fullarticle/2760240 (Links to an external site.) Manchikanti, L., Helm Ii, S., Benyamin, R. M., & Hirsch, J. A. (2017). A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few?. Pain physician, 20(3), 111–138. Second Post: The debate concerning quality of care in hospitals, its “value” and affordability, is increasingly of concern to providers, consumers, and purchasers in the United States and elsewhere. Every nation other than the United States has figured out the need to make trade-offs in health care. In the US health care system, the quest for spending control and improved care has instead focused in the past few years on value-based payment systems. The underlying thinking is that the market is the most efficient arbiter of value, so what is needed is the proper set of incentives to unleash its power. With the right set of incentives, the market is expected to shift resources toward higher-value care and reduce the consumption of low-value interventions, thereby improving care while containing costs. This approach has certainly produced some benefit, but progress is slow. Moreover, and very importantly, it is arguable that a key requirement of a properly functioning market is missing in health care: It is unrealistic to expect that, however engaged they are, consumers (that is, patients) have sufficient information to make rational choices in each health care encounter. Every other nation comparable to the US—European countries, Canada, and Australia—has accepted this limitation and added trade-offs (that is, adjustments to the mix of covered services) to its health care marketplace as a means of compensating for this shortcoming. Moreover, other nations have recognized the need to consider multiple factors beyond quality-adjusted life years (QALYs) in a way that the US has not. Trade-offs apply at two levels. First, they apply at the level of setting the health care budget with a larger overall budget. Second, trade-offs apply within a set health care budget. Given how much of its compensation a company will pay in health care coverage, or the total budget of a given risk-bearing provider, or how much of its budget a government will allocate to health care, what services or interventions should be included in the coverage? Without trade-offs, cost control in the US is left to individual decisions. “Health Care Trade-Offs: A Necessary Reality For Every Health System, ” Health Affairs Blog, March 20, 2018.DOI: 10.1377/hblog20180316.120106