All processes must succumb to evaluation to ensure accuracy and efficiency and detect any mistakes within the process. The same principles apply to performance in the healthcare system. It is extremely important to have a satisfactory performance to upkeep the confidence and trustworthiness received from the people they serve. Evaluations help to improve performance and close gaps within processes that remain open (disparities). There are 3 evaluation criteria used to evaluate healthcare system performance either at a micro level (hospitals, physician practices, long-term care facilities) or macro level (regions, states, nations, and other large groups): quality, equity, and efficiency.
At the micro level, for example: to examine the quality of care being received by minority mothers after labor and delivery in an ambulatory setting by the rate of postnatal complications. If equity is being measured, for example, we would analyze whether mothers of color who are Medicaid holders have more postnatal complications than mothers of color who are private insurance holders. Macrolevel assessments are more specific and difficult because states and regions are assessed using global measures of health outcomes such as life expectancy, morbidity, and mortality rates. Quality of care evaluation for a healthcare system in a certain region would be using the mortality rate for individuals over the age of 65. Efficiency evaluation for a region would include examining global costs for hospitalization for seniors in comparison to those in that specific region. It makes perfect sense that all evaluations must have previous assessments or post-assessments done as well to have a comparison. The only true way to measure growth and performance or concerning rates is to compare assessments using one as a base.
We can think of quality, equity, and efficiency to be the 3 sections of an umbrella. Under the healthcare quality side…..structure (materials, facility, equipment), process (diagnosis, treatment, prevention), and outcomes (population or clinical) are listed. The next section of the umbrella for performance evaluation criteria is equity. Equity ensures that everyone is met where they are in terms of what they need instead of everyone being provided the same assistance (the fair allocation of benefits among those in need of care). Equity is one of the most important principles in healthcare because it helps close the gaps that go unnoticed. Healthcare efficiency is the third piece of the umbrella used to assess healthcare performance. Efficiency ensures that the best quality of care is given at the lowest cost available. The criteria used to assess healthcare performance keeps processes low-cost, fair, and accurate.
It is important to also note that evaluations and assessments being conducted on healthcare performance magnify issues in the healthcare system which, influences change. Before change can occur, values, beliefs, and brainstorming must happen to determine what the change will look like, and which sector holds responsibility (private or public). Because a change in the healthcare system’s performance will affect everyone, it’s important to prepare or brace for impact. By preparing, I am insinuating to brainstorm and have uncomfortable conversations regarding consolidation to redirect funds for change in the United States, to shift the responsibility of public and private sectors. The ratio of private and public sector involvement is uneven in the United States and that plays a role in the structure of the healthcare system along with how it is organized, managed, and financed to achieve the 3 major criteria (equity, efficiency, and quality). Change is not impossible as healthcare systems have endured change in the past centuries but change is complex, costly, and can be very uncomfortable for some.
- Goldsteen, R. L., Goldsteen, K., & Goldsteen, B. Z. (2021). Health Care System Performance/ Debates That Have Structured Health Care System Change. In Jonas’ introduction to the U.S. health care system (pp. 215–290). essay, Springer Publishing Company.
- School of Business, George Washington University . (2021, March 3). How We Can Expect The Healthcare Industry to Change in The Future [web log]. Retrieved January 31, 2023, from https://healthcaremba.gwu.edu/blog/how-we-can-expect-the-healthcare-industry-to-change-in-the-future/.
Hi Eboni,
Great job in hitting the major parts of the chapter readings. This topic was interesting because sometimes the term “health insurance” can simply imply that one is covered to receive the same quality of treatment as the next person no matter the plan. When in fact, as you pointed out, quality, equity, and efficiency are assessed. Great example in bringing up minority mothers who are Medicaid holder vs. minority mothers with private insurance. It is so important that Medicaid holders receive optimal quality and equitable treatment also, since many who can afford or are eligible for private insurances speak on the perks of having private insurance. In relation to this post, I was reading an article about racial inequities in healthcare coverage and found these highlights:
Adults in Medicaid expansion states reported better coverage and access rates, narrower disparities between groups, and greater improvements across nearly every measure between 2013 and 2019.
Medicaid expansion is associated with increased coverage equity, but adults with income below 138 percent of the federal poverty level (FPL) in the remaining non-expansion states are disproportionately Black and Latinx/Hispanic.
So while Medicaid expansion in some states has improved access and equity, there still is work to be done. Especially in covering minorities who are still disproportionately affected.
1. Racial and ethnic inequities in health care coverage and access, 2013–2019. Racial and Ethnic Inequities in Health Care Coverage and Access | Commonwealth Fund. (2021, June 9). Retrieved February 5, 2023, from https://www.commonwealthfund.org/publications/issue-briefs/2021/jun/racial-ethnic-inequities-health-care-coverage-access-2013-2019