Is the United States Quality of care directly impacted by the cost of care or by the access to care? Quality health care services are important for maintaining health, prevent diseases, managing diseases, and reduce unnecessary services and premature death. For more than we can remember, different polls have demonstrated that Americans are dissatisfied with their current health care system and that it is extremely expensive. According to Burke and Ryan from “The Journal of Ethics”, the United States cost positions 26th on the whole planet for life expectancy and ranking poorly on quality. In other words, the United States health care system is failing and costs continue to increase faster than what the American can pay for their services, with the quality of care being also affected. These increase in costs, have driven the possibility to look for wasteful spending, like Medicaid, but it does not correlate with patient outcome, capturing the attention of policymakers. Costs are not strongly related to the quality in the US. For example, the FDA has had approval for new cancer drugs over the years, which can cost over $100,000 per year but are often expected to extend mortality for more than a month, but it does not give better quality of life or cure the disease. The same happens with medical devices that despite of similar survival outcomes, rates of coronary angiography, angioplasty, and bypass surgery following a heart attack, which all have different costs for patients, were 5 to 10 times higher in the United States. This came to the attention of access of care. Access of care is defined “as having timely use of personal health services to achieve the best possible health outcome.” (2018). Access of care requires entering the health care system, having access to sites of care where patients can receive all the services needed to improve their health, and also find providers and physicians who can meet with their needs and whom patients can develop a relationship based on trust and communication. The main purpose for the appearance of Medicaid was to help people obtain health insurance and improve access to health care for those that were uninsured. To the present day even with the Obama care installed, which main purpose was to improve access to health care, the United States still has a poor ranking on insurance coverage. The Commonwealth Fund conducts an international survey of patients from time to time and the last time they surveyed was in 2013. Patients were asked if they could get “same-day” or “next-day” appointments with their provider when they were sick; more than half said no. But on another survey, patients declared that it was easier for them to have health care access after regular working hours in the emergency department but still could not receive the help they needed. The problem here is that even though patients received the help they needed, some still could not afford health care because they could not afford the medications they needed or the provider did not accept their health insurance. The point of this survey is to demonstrate that even though if health care is available, many factors can contribute to affect ease of access to it, for example, the availability of providers who will accept a person's insurance could affect healthcare access, even if they had Medicaid. Also, ease in making an appointment with a given provider can be a factor of access of care. The ability of a patient to pay for the care because even though if a patient is insured, due to cost- sharing copayments and deductibles, they still can’t afford to pay; and also the difficulty of arranging transportation to and from healthcare facilities could also affect a patient from accessing health care although they are insured. So even thought Americans have access to insurance, it does not guarantee access to care for what our health care system needs a fundamental change or it needs to be completely rebuilt. References: Burke, L., & Ryan, A. (2014). The Complex Relationship between Cost and Quality in US Health Care. Journal of Ethics. Carroll, A. (2016, October 24). Why the U.S. Still Trails Many Wealthy Nations in Access to Care [Web log post]. Retrieved January 30, 2021, from https://www.nytimes.com/2016/10/25/upshot/why-the-us-still-trails-many-wealthynations-in-access-to-care.html Factors That Affect Health-Care Utilization. (2018, March 1). Retrieved January 30, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK500097/ Pearl, R., MD. (2017, May 25). Mission Possible: How Healthcare Can Achieve Both Higher Quality And Lower Cost. Forbes.