Cost and Quality Analysis

 

In a paper of 500-1,000 words, describe the relationship between health care cost and quality. Address the following:

Select one public agency and one private agency. Differentiate the roles of these agencies and the major initiatives they have undertaken to address cost and quality in health care. Refer to the Topic 4 study materials for sources related to health care agencies.
Analyze current and projected initiatives to improve quality while simultaneously controlling costs in both the private and public spheres. Describe any unintended consequences that have resulted or may result from these efforts.
Synthesize the implications of these efforts for staff nurses and advanced practice nurses. Include evidence-based practice, relative to cost and quality, in your response.

Sample Solution

Health care is extremely costly in the United States. Although the rate of growth in spending has attenuated in recent years ,per capita spending on health care is estimated to be 50 to 200 percent greater in the United States than in other economically developed countries.Despite leading the world in costs, however, the United States ranks twenty-sixth in the world for life expectancy and ranks poorly on other indicators of quality.Evidence of the low value of United States health care has led researchers to try to identify specific sources of wasteful spending. Many of these efforts have evaluated regional variation in spending patterns,particularly Medicare spending,within the United States.

The first of these events was the Rwandan genocide of 1994, in which, estimates suggest that 800,000 people were systematically killed in the space of 100 days by the Hutu majority government against the Tutsi population. Within this conflict, the UN fundamentally failed in protecting the Tutsi population in Rwanda from the ethnic-cleansing of the Hutu regime. The available evidence affirms this claim, as a small force of only 2500 soldiers known as United Nations Assistance Mission for Rwanda (UNAMIR) was sent to Rwanda in an attempt to alleviate the conflict.(Hehir 2005, p61) This small force however was a futile and unconvincing effort on the part of the UN to palliate the genocide, as, not only did they severely lack arms, but the credible warnings and shocking reports sent by the UNAMIR to the UN Department of Peacekeeping Operations (DPKO) in New York were ignored or rebuffed, over concerns that the UNAMIR may, “exceed the mandate and endanger the lives of UN peacekeepers.”(Ibid) It certainly could be argued that the United States was particularly culpable and restricted the UN in its ability to act as the Clinton administration had made the conscious decision to stop supporting significant UN missions after the torture and televised death of 18 American soldiers in Somalia during a UN humanitarian assistance programme.(Oppong and Gritzner 2015, p60) However this has not stopped the lack of coherent humanitarian intervention in Rwanda being termed by Paul Kennedy as “the lowest point in the UN’s history” and “the single worst decision the United Nations ever made.”(Kennedy 2006, p103) The lack of action undertaken by the UN in the face of the Rwandan genocide sparked international debate surrounding the merits, legality and necessity of humanitarian intervention. Further to this, it raised the problematic debate surrounding unconditional sovereignty, questioning whether the international community had the right to intervene in the case of a humanitarian disaster. (UN, n.d)

These questions would yet again be raised by a second event which proved to be a further catalyst for the emergence of the responsibility to protect doctrine, was the so-called ‘humanitarian intervention’ undertaken by NATO in Kosovo during 1999. Unlike in Rwanda the international community or more specifically NATO undertook military action. This action first started with international condemnation of the Federal Republic of Yugoslavia (FRY) as seen through Security Council resolutions 1160, 1199, and 1998 which compelled the FRY to find a political resolution to the matter. However, when this was not achieved NATO initiated military action, manifesting itself in an eleven-week programme of systematic bombing in Kosovo in order to cease the, “humanitarian catastrophe resulting from the excessive

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