Question

What are fove events between 1900 and the present that have helped shape health care as it is today? Analyze the effects and causes of the event, focusing on the iron triangle of cost, access and quality of care.

Answer 1

A)

• By 1900 to 1950: In 1920, Charles Winslow defined public health as a focus of preventing disease, prolonging life, and pro-
moting physical health and efficiency through organized community efforts.
• During this period, most states had public health departments that focused on sanitary inspections, disease control, and health
education. Throughout the years, public health functions included child immunization programs, health screenings in
schools, community health services, substance abuse programs, and sexually transmitted disease control.
• In 1923, a vaccine for diphtheria and whooping cough was developed. In 1928, Alexander Fleming discovered penicillin. In 1946,
the National Mental Health Act (NMHA) provided funding for research, prevention, and treatment of mental illness.
• 1950 to 1980: In 1950, cigarette smoke is identified as a cause of lung cancer.
• In 1952, Dr. Jonas Salk developed the polio vaccine.
• The Poison Prevention Packaging Act of 1970 was enacted to prevent children from accidentally ingesting sub-
stances. Childproof caps were developed for use on all drugs. In 1980, the eradication of smallpox was announced.
• 1980 to 1990: The first recognized cases of AIDS occurred in the United States in the early 1980s.
• 1988: The Institute of Medicine Report defined public health as organized community efforts to address the public interest in health
by applying scientific and technical knowledge and promote health. The first Healthy People Report (1987) was published that
recommended a national prevention strategy.
• 1990 to 2000: In 1997, Oregon voters approved a referendum that allowed physicians to assist terminally ill, mentally competent
patients to commit suicide. From 1998 to 2006, 292 patients exercised their rights under the law.
• 2000s: The second Healthy People Report was published in 2000. The terrorist attack on the United States on September 11, 2001,
impacted and expanded the role of public health. The Public Health Security and Bioterrorism Preparedness and Response Act of
2002 provided grants to hospitals and public health organizations to prepare for bioterrorism as a result of September 11, 2001.
• 2010: The ACA was passed. Its major goal was to improve the nation’s public health level. The third Healthy People Report was
published.
• 2015: The number of children who have not received vaccines due to parents’ beliefs that vaccines are not safe has increased
nationally. Due to these beliefs, there have been measles outbreaks throughout the nation even though measles was considered
eradicated decades ago.

B)

Iron triangle of health care Cost Containment Access Quality

Many healthcare systems are evaluated using the
Iron Triangle of Health Care—a concept that
focuses on the balance of three factors: quality,
cost, and accessibility to health care . This concept was created in 1994 by Dr. William Kissick (Kissick, 1994). If one factor is
emphasized, such as cost reduction, it may create
an inequality of quality and access because costs
are being cut. Because lack of access is a problem
in the United States, healthcare systems may focus
on increasing access, which could increase costs. In
order to assess the success of a healthcare delivery,
it is vital that consumers assess their health care by analyzing the balance between cost, access,
and quality.Many experts use the Iron Triangle to ana-
lyze large healthcare delivery systems, and, as a
healthcare consumer, you also can evaluate your
healthcare delivery system using the Iron Triangle.
An effective healthcare system should have a bal-
ance between the three components.

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