Melting the iron triangle: Prioritizing health equity in dynamic, innovative health care landscapes
As a grasp of well being administration (MHA) pupil finishing my administrative residency within the well being know-how trade, I selected to dedicate my capstone undertaking to a subject positioned on the intersection of what I had discovered in graduate college and what I had discovered throughout my residency. Whereas administrative residencies are usually in a hospital or consulting setting, I matched with a primary-care-focused digital well being document firm because the group’s first administrative resident. Throughout my residency, I gained an excellent higher understanding of the complexities of the U.S. well being care system whereas benefiting from the pliability and independence afforded me to pursue my passions and concepts as an early careerist. Because it seems, well being know-how is the proper realm for leveraging administrative well being care information within the pursuit of well being care improvements.
Having accomplished my graduate diploma in a distant setting throughout the pandemic, I acknowledge how privileged I’m to have the instruments and sources wanted to attain tutorial success digitally and keep my bodily and psychological well being digitally by way of telehealth. Finding out the current, multifaceted developments in well being know-how and well being disparities that existed lengthy earlier than COVID-19, I rapidly turned excited about analyzing the connection between well being innovation and well being fairness.
Pandemics have lengthy catalyzed sturdy, fast adjustments to well being care establishment. Although the devastation and ache attributable to the COVID-19 pandemic persist, it’s by way of public well being crises that essentially the most impactful developments are made to the well being care system as an entire. Although systematically flawed, America’s well being care panorama continues to signify a hub of medical and technological innovation, quickly adapting to satisfy evolving calls for. As well being care leaders proceed to satisfy the challenges of the quickly evolving well being care setting, a serious impediment stays: the iron triangle.
The idea of the iron triangle, first launched in Medicine’s Dilemmas: Infinite Needs Versus Finite Resources by William Kissick in 1994, asserts that the weather of price, high quality, and entry in well being care can’t be concurrently improved with out worsening not less than one of many different components. On this new period of digital well being applied sciences, the iron triangle is extra related than ever, with developments extensively embraced throughout the pandemic – similar to telehealth – filling the speedy want for entry to well being. However are the populations at biggest threat by way of entry, high quality, and price of well being care those really benefiting from these improvements?
Because it seems, regardless of digital well being applied sciences exhibiting promise for the way forward for well being care, weak populations are sometimes left with an excellent bigger well being disparity hole. Due to this unintended consequence of well being innovation, disparities ensuing from the digital divide mix with current, multi-factor inequities in well being care.
The most important revolution in affected person expertise
Whereas the technological growth within the well being care discipline shouldn’t be a circumstance of the pandemic, the accelerated roll-out and adoption of digital options actually are. And fast innovation within the well being care know-how discipline shouldn’t be a foul factor in itself. Well being care know-how discoveries enhance well being care entry, high quality of life, affected person security, and even save lives – for instance, distant affected person monitoring units and robotic surgical procedure. Though digital well being improvements have considerably impacted affected person engagement by empowering people’ autonomy over their very own well being, these fashionable well being instruments may yield a a lot higher influence in the event that they weren’t primarily utilized by populations already advantaged by way of price, entry, and high quality of care.
In contradiction to the iron triangle, some argue that “digital communications and telepresence facilitate holding sufferers away from the bodily facility – ideally, at residence – thereby rising entry and lowering prices, and seems to be doing so with no lower in high quality.” Nonetheless, the developments in digital well being care themselves haven’t resulted in a profound influence on weak populations and well being fairness. With out predetermined methods for leveraging digital well being improvements by way of a well being fairness lens, price, entry, and high quality could not enhance for individuals who want it essentially the most.
