Upon successful completion of this module, the student will be able to satisfy the following outcomes:
? Case
o Identify and discuss the standards by which a health care system may be evaluated.
o Apply the standards of evaluation in comparing and contrasting the U.S. and English system.

o Apply the evaluation standard of quality in the care provided in a primary care setting.
o Identify and discuss strategies to improve the care in certain settings.
? Discussion
o Discuss the impact on the quality of care due to limited access and higher costs.
Module Overview
Access refers to the ability of those in need of health services to obtain appropriate care in a timely manner. Can you get medical care when you need it? If yes, you have access. Note: Access is not the same as health insurance coverage, although insurance coverage is a strong predictor of access. Access has also been defined as the timely use of needed, affordable, convenient, acceptable, and effective personal health services. (Shi and Singh, 2005)
Cost of Care
The term cost can carry different meanings in the delivery of health care services. From the consumers’ perspective, cost generally means price. From the providers’ perspective, cost means the cost of producing health care services (including salaries, capital costs, and supplies). From the national perspective, cost refers to how much a nation spends on health care services. This is commonly known as health care expenditures, and is measured in relation to the Gross Domestic Product.
The United States spends a larger share of the gross domestic product (GDP) on health than any other major industrialized country. In 2002, the U.S. devoted 15% of the GDP to health compared with 11% each in Switzerland and Germany and nearly 10% in Iceland, France, Canada, Norway, and Greece, countries with the next highest shares.
According to Health, United States 2005, the major sources of funds for hospital care in 2003 were Medicare (30%) and private health insurance (34%). Physician services were primarily funded by private health insurance (50%) and Medicare (20%).
In contrast, nursing home care was financed primarily by Medicaid (almost 50%) and out-of-pocket payments (more than 25%). The Medicare share of nursing home expenditures has risen from 3% in 1990 to 12% in 2003.
Health Care Cost Factors
There are several factors associated with the rise in health care spending. These factors are apart from general inflation in the economy. Read this Power Point presentation on Health Care Cost Factors associated with rising health care costs.
Quality of Care
“Quality” has been overshadowed by the emphasis placed on access and costs of health care delivery. One major factor causing this phenomenon is the difficulty associated with defining and measuring “quality.” This difficulty notwithstanding, in recent years “quality” has taken center stage primarily due to the growth of managed care and its emphasis on control of utilization and cost containment. The concern is that managed care’s focus on utilization and costs has and will continue to adversely impact quality of care.
The Institute of Medicine has defined quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”
In its report, Crossing the Quality Chasm, the IOM specifies six guiding aims for principles of change in reforming the American healthcare system: Health care should be safe, effective, patient-centered, timely, efficient, and equitable.
Some excellent articles can be found in the IOM web site – click here and input quality as your search word.
Quality Assessment refers to the measurement of quality against an established standard. It includes the processes of defining how quality is to be determined, identification of variables or indicators to be measured, statistical analysis, and interpretation of data. (Shi & Singh, 2005)
Quality Assurance is a step beyond quality assessment, and is defined as the process of institutionalizing quality through ongoing assessment and using the results for continuous quality improvement. Quality Assurance is a system wide commitment to engage in ongoing improvement of quality.
See this Power Point presentation on Quality Implications.