"You can't have all three; pick two."

“You can’t have all three; pick two.”

Many parents, including me, tell this to their kids.??

However, this statement is based on the concept of the Iron Triangle, sometimes referred to as the Project Management Triangle.

“Fast, good, or cheap – pick two.”

I have been thinking about how this concept applies to healthcare.??

??FAST:

We want to receive care when we need it. Unfortunately, most of the time, we must wait weeks, even months, before getting a chance to see a physician. In healthcare, “fast” translates into access.?

??GOOD:

We all expect to receive the best care possible. Regarding healthcare, “good” is not good enough – we want great care. We need effective care that will restore or maintain our health. In healthcare, “good” translates to high quality.

??CHEAP:

We want to get affordable healthcare. In healthcare, the cost is complicated. Most people use insurance to pay for healthcare. A consumer measures cost as the expense of the insurance premiums or out-of-pocket copayments. Most of the time, consumers do not pay attention to how much the insurance companies pay their healthcare providers.?

????? Good and Cheap, but not Fast:

Most healthcare organizations provide “good” and “inexpensive” care but with poor access. The quality of care is high as measured by various national rankings. Health plans such as HMOs offer lower premiums and lower out-of-pocket costs. However, access is limited, and patients often must wait long before seeing their physicians.

????? Good and Fast, but not Cheap:

Concierge medicine is a membership or retainer-based model of care that could fall under this category. Patients pay a monthly or annual fee to be a member of a physician’s practice. This option is not “cheap.”??However, it allows for same-day office visits and 24/7 access to a physician. This option is “fast” as it offers excellent access.

The quality of care is often “good.” Most physicians who pursue concierge medicine have well-established practices and years of clinical experience. Market forces often demand high quality since patients will leave the practice if they experience poor-quality care.???Some argue that concierge medicine might force physicians to “say yes” inappropriately when they should be saying no. For example, a physician might feel obligated to approve a request for an antibiotic when it is not indicated.

????? Cheap and Fast, but not Good:

An extreme example is botched cosmetic surgeries or injections provided by unlicensed people. Another debatable example is related to care provided through various urgent care or same-day clinics, either in person or virtually. Many of these clinics offer care by providers who are not physicians. Some of these clinics do not have an appropriate level of supervision by physicians, so patients receive care from a provider with limited experience. While many great non-physician providers deliver excellent care, physicians must complete more years of training and be skilled in diagnosing unusual and dangerous conditions that a less experienced clinician might easily miss. Additionally, most of these same-day clinics cannot provide care for patients with complex needs and are not connected to a more extensive network of specialists.

Which would you choose if you had to choose only two out of the three (good, cheap, fast)?

Regarding healthcare, I believe we need all three – excellent quality, easy access, and affordable care. I want all three for my family, and for all patients.

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