Running head: ADDING THE CARE BACK INTO HEALTHCARE

The National Quality Strategy Provision of the Patient Protection and Affordable Care Act and
its effect of adding the care back into Healthcare
Jessica Joseph
California State University, San Bernardino
HSCI 455
November 14, 2013
Policy Analysis Term Paper

Running head: ADDING THE CARE BACK INTO HEALTHCARE

Background
The Patient Protection and Affordable Care Act (PPACA) is a statute enacted by the
federal government to improve upon the current U.S. healthcare system by instating several
measures to increase affordability, access, and the state of the quality of care (Meltzer, 2011).
Any notion to improve upon the aspect of quality for healthcare systems has not been made for
the past thirty years (Brook et al., 2000).
Under the PPACA, the National Quality Strategy (NQS) is a policy mandated to the
improvement of the state of the nations quality of healthcare (About NQS, 2013). The NQS
creates a single set of regulations and tools to measure healthcare performance, initiatives, and
reporting methods (United States, 2013). These unified methods create reliability and efficiency
for all patients, healthcare providers, and investors alike (United States, 2013). The aim of the
NQS is to create a healthcare system focused on the patient; easy access to service, and to
generally improve the overall health of individual citizens as well as the population as a whole
(United States, 2013). This policy provides six strategies to account for advancement and
development, which are: reducing harm to patients, facilitating more coordination and
communication, empowering patients, implementing evidence-based prevention and treatment
plans, promoting healthy behaviors and environments , and developing and using new delivery
models (About NQS, 2013).

Supporting Argument
A majority of healthcare organizations have not made progress in their delivery of
effective quality of care; Chassin & Galvin (1998) attribute this to the fact that there is not one
standard representation of a high-quality healthcare organization. In 2006, Bengoa, Kawar, Key,
Leatherman, and Massoud stated, Even where health systems are well developed and resourced,

Running head: ADDING THE CARE BACK INTO HEALTHCARE

there is clear evidence that quality remains a serious concern, with expected outcomes not
predictably achieved and with wide variations in standards of health-care delivery within and
between health-care systems. Healthcare quality issues are an extreme burden on U.S. patients,
who face the consequence of extensive debt, impaired bodily function, and/or death (Chassin &
Galvin, 1998).
The poor state of healthcare quality can be assessed into three separate factors: underuse
of healthcare services, and the overuse and misuse of medicine (Institute of Medicine, 2001).
The underuse of healthcare is multiplied due to the fact that millions of Americans do not have
health insurance coverage (Chassin & Galvin, 1998). Without the means to access healthcare
services, Americans are forced to wait to seek treatment until they are in extreme deplorable
conditions, which in turn, results in a high volume of Emergency services (Chassin & Galvin,
1998). The exhaustible use of emergency medical services weighs heavily on the overall
expenditures (Chassin & Galvin, 1998). The uninsured raise the cost of production for the
healthcare systems due to their inability to pay, resources are exhausted and not easily replaced
(Chassin & Galvin, 1998). The result of the strain on the uninsured population is an added
debility and decreased life expectancy (Chassin & Galvin, 1998). Despite socioeconomic
disparities, those without health insurance had a 25% greater chance of dying within 12 years
(as cited in Chassin & Galvin, 1998).
The overuse of medicine presents extenuating health effects (Chassin & Galvin, 1998).
Chassin & Galvin (1998) state that, 21% of all antibiotic prescriptions (a total of 23.8 million
prescriptions) given to ambulatory adults or children in 1992 were used to treat colds, other
upper respiratory tract infections, or bronchitis, conditions for which antibiotics are ineffective
and pose the risk of life-threatening reactions and an increase in antibiotic resistance. The
unnecessary spending for treatment of misdiagnosed medical conditions results in an increased

Running head: ADDING THE CARE BACK INTO HEALTHCARE

total spending and increased adverse effects in patients (Chassin & Galvin, 1998). Such burdens
could have been avoided altogether (Chassin & Galvin, 1998).
The misuse of medicine is caused by the avoidable impediment of treatment, which
result in impairment or death (Chassin & Galvin, 1998). The wrongful diagnosis of medical
conditions and the wrong amount of medication prescription can be easily fixed before any
physical harm can occur; but when these issues go unnoticed adverse effects transpire. Studies
have found that, patient injuries resulting from the administration of medications occur at the
rate of about 2,000 per year in each large teaching hospital; about 28% are preventable given
current knowledge (as cited in Chassin & Galvin, 1998).
According to Chassin & Galvin (1998) these three factors in poor quality arise in all
forms of delivery systems at the same regularity across the country. Healthcare quality can be
precisely measured; these measures provide sufficient data to evaluate causes and levels of
concerns (Chassin & Galvin, 1998). The current state of the Quality of Care in the U.S. is in dire
need of a unified structure of measurement criteria (Bengoa et al., 2006).
The issue of the under-usage of healthcare is addressed by improving the availability and
affordability to health care services not only in general by the PPACA, but specifically through
the National Quality Strategy policy. The overuse and misuse of medicine quality issues are
addressed by the National Quality Strategy policy, which will be improved based on the first
priority, making care safer by reducing harm caused in the delivery of care (United States,
2013).
A proposal to overturn the PPACA, stems from the concerns about the overall cost to
enact the PPACA. Efforts to increase the use of healthcare systems will result in better healthcare
quality; however, it will also cause an increased expenditure (Chassin & Galvin, 1998).
According to the research of Chassin & Galvin (1998) measures to decrease the overuse of

Running head: ADDING THE CARE BACK INTO HEALTHCARE

medicine will not only benefit the overall quality of healthcare delivery, but it also cut down
spending as well. In the same instance, measures to decrease the misuse of medicine improve
healthcare quality as well as eradicating the cost of unnecessarily treating health conditions
(Chassin & Galvin, 1998). As stated by Chassin & Galvin (1998) a majority of the initiative to
improve the quality of healthcare delivery will result in a decrease of government spending.

Opposing Argument
There have been several arguments that pose to overturn the PPACA. The majority of
reasons cite that money is the main concern. The PPACA was passed with the assumption that it
would not have any impact on the current financial deficit of the nation (Huntington et al., 2011).
As stated by Huntington, Covington, Center, Covington, & Manchikanti (2011) the initial cost
predictions for enacting the PPACA were erroneous; instead of the initial increased expense of
6.1% it will rise to 6.3% annually. The total cost of enacting the PPACA in one year is estimated
to be $2.6 trillion dollars (as cited in Huntington et al., 2011). Enactment of the PPACA is
predicted to increase public spending, private spending, and out-of-pocket spending (Huntington
et al., 2011). Overall, the issue posed by opposing views state that its highly unlikely the
PPACA could, curb the sharp increase in cost over the long-term (Huntington et al., 2011).
Due to these concerns about the overall cost to enact the PPACA result in a proposal to overturn
the PPACA (Huntington et al., 2011).

Recommendation
In order for nationwide progress to be made spending must occur. Regardless of the
expense, the current state of the nations health is in need of tremendous change. Government
spending can be allocated for several measures, healthcare expenditures should be a priority. The

Running head: ADDING THE CARE BACK INTO HEALTHCARE

health of our nation will not improve without the renovation to the delivery of our health care
systems services. Although there might be an increase in government spending as a result of
enacting the PPACA a majority of it result in the overall decrease of expenditures; therefore, the
cost is much less significant than the benefits of endorsing the PPACA.
If the PPACA is overturned, then by default the quality of care from all healthcare
systems will be affected. The state of healthcare quality will remain poor since there wont be
policies in place for improvements. As a result no progress will be made in the overall state of
healthcare quality. Relying on each individual healthcare organization to improve their standard
of quality through their own measures will not suffice. I recommend that the PPACA remain in
order for the National Quality Strategy provision to be enacted. The National Quality Strategy
policy is a unified structure to measure healthcare delivery and reporting methods; it allows all
healthcare systems one standard in which to model their efforts. Without a healthy population to
drive the innovation and advancement in all fields of business, technology, science, medicine,
industry, etc., the progress of the nation will remain stagnant or worse, decline. The National
Quality Strategy completely reforms the healthcare delivery process. Adding the care back into
healthcare is a redress that is a necessity in improving the overall health of the American citizens
and the United States as a whole.

Running head: ADDING THE CARE BACK INTO HEALTHCARE

References
About NQS. (2013). Working for Quality. Agency for Healthcare Research and Quality.
Retrieved November 1, 2013, from http://www.ahrq.gov/workingforquality/about.htm
Bengoa, R., Kawar, R., Key, P., Leatherman, S., & Massoud, R. (2006). Quality of care: a
process for making strategic choices in health systems. World Health Organization.
Brook, R. H., McGlynn, E. A., & Shekelle, P. G. (2000). Defining and measuring quality of care:
a perspective from US researchers. International Journal for Quality in Health Care,
12(4), 281-295.
Chassin, M. R., & Galvin, R. W. (1998). The urgent need to improve health care quality. JAMA:
the journal of the American Medical Association, 280(11), 1000-1005.
Huntington, W. V., Covington, L. A., Center, P. P., Covington, L. A., & Manchikanti, L. (2011).
Patient protection and affordable care act of 2010: Reforming the health care reform for
the new decade. Pain Physician, 14, E35-E67.
Institute of Medicine (US). Committee on Quality of Health Care in America. (2001). Crossing
the quality chasm: A new health system for the 21st century. National Academies Press.
Meltzer, C. (2011). Summary of the affordable care act. AJNR. American Journal of
Neuroradiology, 32(7), 1165-1166.
Stone, J., & Hoffman, G. J. (2010). Medicare Hospital Readmissions: Issues, Policy Options and
PPACA. Congressional Research Service Report for Congress. In Congressional
Research Service, Prepared for Members and Committees of Congress. Washington, DC.
United States. Department of Health and Human Services. National Strategy for
Quality Improvement in Health Care: 2013 Annual Progress Report to Congress.
Retrieved November 1, 2013, from
http://www.ahrq.gov/workingforquality/nqs/nqs2013annlrpt.pdf