Question

1. What are geriatric syndromes? How are they different than chronic conditions? Describe how care may be affected by the extent to which symptoms are thought to be “normal” symptoms of aging.

2. The passage of the Affordable Care Act was the largest change to health policy in 50 years. Using the Healthcare Access, Quality, and Cost Triangle, explain first what the triangle means, and use an example from this policy to illustrate how it works.

3. Variations in healthcare costs reflect both over-treatment and under-treatment among older adults. Explain what drives differences such as these across regions and what it may suggest about healthcare quality.

Answer 1

1. Geriatric syndromes are various conditions prevalent among old age population. In geriatric syndrome the person may experience compromised functioning of multiple organ systems compromising their functional ability. Chronic conditions or chronic diseases are conditions that are present from 1 year or more and that require ongoing medical interventions and limits activities of daily living. Examples of chronic conditions are cancer and diabetes mellitus. Chronic condition can be present in any age group but geriatric syndromes are present only in old age.

Normal signs of ageing includes greying of hair, loose and wrinkled skin, loss of teeth, weakness of bones, diminished sensory responses hearing, taste, vision etc. Some common geriatric syndromes includes falls, osteoporosis, dementia, delirium, urinary incontinence, sleep deprivations, osteoporosis, weight loss. All these manifestations may appear alone or in group and is associated with ageing process but requires medical attention to prevent further complications and restore well being. When geriatric syndromes are neglected and considered as a part of normal ageing, it causes debilitating illness.

2. Healthcare Access, Quality, and Cost Triangle is also known as the Iron triangle of health care. It is a concept which explains that access, cost and quality cannot be improved simultaneously. Improvement in one area may cause decline in at least any one of the other two factors.

Affordable care act or Patient Protection and Affordable Care Act commonly called as Obamacare was passed in order to reform the private insurance market, to change the process of medical decision making and to ensure provision of effective medical services for poor income groups. The original goal of Obamacare was also to increase the access and reduce the cost. The law was a success in increasing the access of public to health care services but did not succeed in reducing the cost. Finally reducing cost and wastage of resources in health care sector still remains as a challenge, that gives credence to the iron triangle concept.

Key aspects of Affordable Care act were mandatory insurance coverage for all, expansion of medical coverage to the poverty level up to 133%, subsidies on purchase of health insurance, promoting healthy lifestyle by awareness campaigns, realignment of incentives for insurers and health care workers. But experts who favors iron triangle concept in regards with the Affordable Care act states that access, quality and cost are inversely related. For example a $10,000 can be spend for an MRI scan for one whole day for an individual patient by using all combinations of repetition times and echo times by a radiologist. This shows high quality with increased expense and restricted access. Whereas at the same cost MRI scan be done for 100 patients a day by the same radiologist, but one individual will receive only one sequence of scan. This is an example for low cost but easy access. So as to achieve the expanded coverage goal, Affordable care act may have the following consequences: no change in previous cost or quality of service, reduced cost with reduction in quality or increased cost with increase in quality, reduced cost and improved quality but less access.

3. Reasons for difference in quality and cost of health care services across different regions are availability of resources, especially availability of qualified health care professionals, Another reason may be the availability of health care centers or hospitals at different areas, the health status of the population residing at that particular area, medical training as well as their practice patterns. Inefficient health care delivery, fraud, malpractice, social, economics and cultural characteristics of the population may also affect the health care services.

Researches proves that spending  more on health care services will not improve the quality of service or provides a favorable outcome. The technical quality and reliability of the hospital services are important factors that determine quality of service. Studies also proved that states with higher spending rate on Medicare has poor quality rankings whereas the states who had more health spending got better quality rankings.