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Access, Cost, and Quality for APNs

Access, Cost, and Quality for APNs

The guarantee of quality health service delivery is critical in realizing better clinical outcomes. However, with the increasing scope of the healthcare system and the exponential growth of patients seeking health services, commercialization of the healthcare system has ensued. With the free-market economy prevailing in the U.S., non-governmental organizations seeking to reap from the huge potential healthcare market continue to make a presence and generally interfere with the health system provision (Brown, 2018). This has given rise to unprecedented concerns of access and cost, with these organizations focusing entirely on the cost of healthcare rather than quality. The ramifications of this paradigm shift are felt by the patient who has to bear the burden of not up to standard quality healthcare and restricted access to these services. This paper seeks to analyze access, cost, and quality of quality environments for an APN and the recent quality initiative to maintain the quality of healthcare provision in a changing health landscape.

The overall health of communities is only assured when they can access quality health services. Access to healthcare supersedes all efforts to attain health among communities and individuals. Access entails entry into the healthcare system, accessing the various sites of care at which the very needed health services are available, and finding healthcare providers who can meet the individual patient’s needs (Joel, 2013). An accessible healthcare service provision system should easily be approachable, available, acceptable, accommodative, and affordable. Whereas various government’, non-governmental organizations, and individuals advocacies towards the attainment of accessible healthcare services, several disparities are still evident, with healthcare access remaining  considerably difficult among some populations. Such issues as insurance and the ability to pay for health services and the ability and likelihood to utilize the available health services, still jeopardize access to healthcare as described below.

The affordability of healthcare services is one of the greatest determinants of accessible health services. Affordability is ensured by insurance coverages and the ability to pay directly for the services received. Individuals with low-income experience difficulty obtaining health covers and raising the fees required to foot medical bills. Whereas the expansion of the Medicaid program increased the number of insured Americans and improved access to healthcare significantly, these individuals’ insurance covers, particular difficulties still exist in copayments and the scope of these insurance coverages. Multiple services, such as mental and oral health are still not fully covered by most insurance companies (Joel, 2013). Additionally, these individuals have to juggle between copayments and other routine financial demands that are obligatory. In most instances, underinsurance is the result.

Another issue related to accessibility to care is the ability and likelihood to use health services. Access is only ensured when the health providers and the health-providing centres are reachable to people. Inaccessibility attributable to remoteness and poor infrastructural developments, as evident in some rural areas, greatly impedes quality healthcare delivery. These areas have been implicated in the insufficiency of health providers, resources, and equipment to deliver these health services (Huot et al., 2019). Additionally, poor transportation due to the remoteness of these rural areas and lack of proper initiatives to improve the transportation system may greatly hinder these people’s ability to access healthcare and health providers to access these areas to offer their services.

Accessibility to healthcare remains a significant component of the healthcare delivery system. Efforts should thus be placed to enhance access to care. Such efforts as improving infrastructure, insurance coverage, and empowerment are necessary to improve access to care. It is, however, paramount that special considerations be made on the cost of healthcare services. Cost implications remain to be a major hindrance to the affordability of healthcare. Various issues pertaining cost are described below.

The cost of healthcare provision in the U.S. has skyrocketed recently, with all sectors of healthcare service delivery being implicated in such increases. This has been attributed, in part, to the profitability potential of the healthcare system and the capitalistic nature of the U.S. economy. Despite this overall increase in cost, challenges still exist in curtailing this rise due to the profound difficulties of inaccurate determination of the specific attributing factor to this rise. However, evidence of all stakeholder involvement suffices the conclusion that the high cost is driven by the healthcare market players ranging from the patients who over-relies on the third-party payers, health insurers who seek to generate more revenue than the company willing to spend (Brot-Goldberg et al., 2017). Government targets lesser expenditure from taxpayer money but is ever willing to enhance access to care and pharmaceutical companies who earn more revenue from raised market cost.

Patients, the key players in the healthcare system, bear the burden of such misaligned incentives. The ripple effects of these actions are usually weighed down on the final products, which are the services and medication, and the effect is often evident in the higher cost of health services and medicines. The patients are sometimes caught on the hook, and in these scenarios, they become the contributing factor to their predicaments. The unwillingness of patients to participate in cost reduction incentives that may involve an upfront investment of their money may, in the long run, increase the cost of their medication. Failing to adopt disease prevention habits such as proper dieting, paying for the gym and exercising, immunization and vaccination, and frequent disease checkups may compound into other health problems in the future that may require more out-of-pocket spending to remedy.

Whereas cost implications on healthcare remain to hinder the affordability and consequently access of healthcare, it remains every stakeholder’s responsibility to correct the situation. Effective reduction in the cost of healthcare is only attainable when all stakeholders in the health system are involved.

Quality remains of significant concern despite the changing landscape of healthcare environments. The healthcare system must maintain quality healthcare provision to enable better patient clinical outcomes. Quality is a multi-faceted aspect that involves the healthcare providers and the patients and draws other stakeholders, such as the governments via regulation and policies and pharmaceutical manufacturers, among others (Fatima et al., 2019). The evaluation of a healthcare system to determine the quality and which are relatable to the APN structures include morbidity, mortality, patient satisfaction, and health status.

Assessment of quality of care can be done at the micro level involving the patient, their providers, and the healthcare setting involved or at the macro level focusing on the outcomes and the cost-effectiveness of the care process. Quality assessment at the micro-level interrogates aspects of the patients, providers, and the hospital that could alter the quality of the health provision process. Such aspects as the availability of adequate healthcare providers, their specialty, willingness to offer their services, adequacy of hospital resources, and patient’s health-seeking behaviour, among others, directly determine healthcare quality. Insufficiencies in any of these components jeopardize the quality of care significantly.

Macro-level perspectives draw variables such as the cost-effectiveness of care to the entire society and clinical outcomes of the health delivery processes. The Cost-effectiveness of a treatment process is nearly as important as the treatment process itself. A pertinent question that needs to be addressed in the treatment process and decision-making is the cost implications of the process to the care facility and the patient. In this regard, a decision has to be made on the safest and least costly modalities of treatment that will enable the preservation of life. Clinical outcomes are the most important quality parameter (Titeca, 2016). Attention is increasingly being focused on the patient’s clinical outcomes as the hallmark of quality assurance in the health delivery system. Better clinical outcomes are associated with good quality. Such outcomes include improving the patient’s quality of life and alleviating disease. The macro-level perspectives have drawn considerable attention among various organizations, support groups, and governments, with policies being formulated to regulate these aspects.

The necessity of a quality environment in the healthcare sector has warranted various initiatives to maintain quality. These initiatives to maintain quality are dependent on predefined measurable standards of quality. The objectives of health quality measurements should also be clearly outlined to enable a better understanding of the effects of the services being assessed on societies and individuals (Busse, 2017). Such objectives may include but are not limited to assessing facilities and individual performance per the established standards, gathering and drawing analysis from the collected data to inform the various improvement efforts, and drawing comparisons between providers to inform the buyer’s and consumer’s choice of products. Quality health initiatives have been taken by both government and private sector levels.

The federal government’s initiatives towards quality care are explicitly expressed through its agencies. Such agencies as the AHRQ and the CMS, under congressional policy directions, have continued to focus significantly on quality in the execution of their activities. AHRQ, for instance, seeks to improve clinical outcomes and enhance the quality of healthcare provision by carrying out internal and external research programs that are targeted at the same. Such issues as addressing medication errors, the safety of the patients, and increased access to healthcare services remain a priority to this group (Joel, 2013). The CMS ensures quality and effective care to its Medicaid and Medicare users by setting appropriate standards for quality in their service delivery. The CMS has also been involved in a robust, targeted quality maintenance initiative emphasizing long-term-care homes, hospitals, and home care. These initiatives utilize several techniques ranging from assessing and disseminating information about the quality of Medicaid facilities to fostering clinical outcome-based improvements on quality in these setups.

The state governments and private sector are not left behind either. Various state governments have been involved in measuring and reporting quality in their state-run healthcare setup as well as in hospitals under their regulation (Joel, 2013). Private organizations such as employers, professional organizations, and purchasers have also been involved in such measurements and reporting of quality. Accrediting entities also play a pivotal role, with some being involved in the measurement of specific outcomes of the patients. The overall objective of all these initiatives is to measure the quality of a healthcare delivery process by measuring and reporting the possible outcomes. The APNs’ performance as a component of a delivery process is thus continuously being measured and therefore points to the need for an APN to be well conversant with the approaches in quality measurement and improvement as a guide to their routine practice.

Attaining and maintaining good health is only guaranteed when healthcare provision services are accessible, affordable, and of good quality. Inaccessibility to healthcare due to infrastructural and socioeconomic reasons remains a challenge to many Americans. The high cost of healthcare is attributable to several reasons, ranging from stakeholders to the patients themselves also impedes the attainment of quality healthcare provision. The quality of the health provision system also forms the basis for quality service provision. Therefore, governments and the private sector must work collaboratively to lay down strategies and initiatives to maintain satisfactory quality standards that are required in the healthcare sector.


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Brown, M. (2018). The Moralization of Commercialization: Uncovering the History of Fee-Charging in the U.S. Nonprofit Human Services Sector. Nonprofit And Voluntary Sector Quarterly, 47(5), 960-983.

Busse, R. (2017). Improving healthcare quality in Europe. Busse R, Panteli D, Quentin W. An introduction to healthcare quality: defining and explaining its role in health systems. In: Busse R, Klazinga N, Panteli D, et al., editors. Improving healthcare quality in Europe: Characteristics, effectiveness, and implementation of different strategies [Internet]. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2019. (Health Policy Series, No. 53.) 1.

Fatima, I., Humayun, A., Iqbal, U., & Shafiq, M. (2019). Dimensions of service quality in healthcare: a systematic review of the literature. International Journal For Quality In Health Care, 31(1), 11-29.

Huot, S., Ho, H., Ko, A., Lam, S., Tactay, P., MacLachlan, J., & Raanaas, R. (2019). Identifying barriers to healthcare delivery and access in the Circumpolar North: important insights for health professionals. International Journal Of Circumpolar Health, 78(1), 1571385.

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Titeca, H. (2016). Healthcare Spending: The Role of Healthcare Institutions from an International Perspective. Marble, 2.

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on Health Care Utilization and Adults with Disabilities. Healthcare Utilization as a Proxy in Disability Determination. Washington (D.C.): National Academies Press (U.S.); 2018 Mar 1. 2, Factors That Affect Healthcare Utilization. Available from:


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Access, Cost, and Quality for APNs

Discuss the access, cost, and quality of quality environments, as well as recent quality initiatives (See Chapter 22 and Table 22.1). Student is to reflect on the relationship between quality measures and evaluation and role development. In addition, describe this relationship and note how the role of the APN might change without effective quality measures.

Access, Cost, and Quality for APNs

Access, Cost, and Quality for APNs

  • Length: 1500 words, double-spaced, excluding title and reference pages (required)
  • Format: APA 7th Edition

See USU NUR Research Paper Rubric for additional details and point weighting.



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