How to write a nursing essay on Access, Cost, and Quality for APNs

How to write a nursing essay on Access, Cost, and Quality for APNs

Access, cost, and quality are the three ingredients of a stable healthcare system. These aspects of care determine how people receive healthcare services and how the use of resources enables the utilization of available care. Currently, the United States healthcare system consists of public and private partnerships to ensure the people receive the right care at affordable prices. Despite the US being the highest spender in healthcare, the country ranks low among developed nations in terms of healthcare quality (Montero et al., 2022). The current legislative and institutional reforms have failed to enhance coverage and the cost of healthcare. Advanced practice nurses (APNs) are in a better position to ensure healthcare delivery is improved and costs reduced through legislative initiatives. This paper discusses the concepts of cost, access, and quality and how the role of APNs might change without effective quality measures.


Facilitating access is mainly concerned with helping people to command appropriate resources to improve their health. Access to healthcare refers to the capacity of the people to receive care and healthcare-related services (Dawkins et al., 2020). When managing illnesses, access is important because it determines the ease of reaching healthcare providers and the availability of necessary resources to treat the patient. Access to healthcare can be described in four aspects including the adequacy of healthcare services, gaining access to the facility, relevance of the services provided, and availability of services (Dawkins et al., 2020). For example, the services offered to the people must be adequate to meet the demands of the population. Secondly, the people must be able to get physical access to the healthcare facility and afford the healthcare services available. The people must also gain access to relevant and effective services for the access component to be achieved. Lastly, the healthcare organization must have the necessary services required for treatment and disease management for the access to be complete.

Access to healthcare remains a major problem for millions of Americans, especially those living in rural areas and minority groups. These communities lack essential components of healthcare access like health insurance and this limits how they receive care. While a series of special payment initiatives like medicare and Medicaid is available, some communities fail to afford health insurance and are forced to spend their capital when sick. Research establishes that access to healthcare is impaired by things like low health literacy levels, poverty, cultural differences, and high unemployment rates. For instance, about 9.6% or 31.1 million Americans lack health insurance (. Such people can be close to healthcare facilities that have all the required resources but fail to access these services because of payment issues.

Inadequate health insurance coverage is one of the largest barriers to healthcare access (Dawkins et al., 2020). Those without health insurance are forced to utilize out-of-pocket costs that lead to delays in going to the hospital and accessing medications. For example, those with chronic diseases like diabetes and cancer may fail to receive preventive services due to cost issues. Similarly, children without health insurance coverage may fail to receive appropriate care for conditions like asthma leading to poor health outcomes. Apart from these aspects, things like healthcare worker shortages may limit the type of care given to patients (Dawkins et al., 2020). For example, physician shortage may lead to failed visits and delayed access to healthcare services. Expanding healthcare access can be an important step toward reducing healthcare disparities and ensuring minority groups receive the care they need.


The high cost of healthcare is thought to be a major factor affecting the health of populations and the performance of healthcare systems. The United States healthcare system is faced with the challenge of providing good healthcare services due to cost issues. Recent reports indicate that the US healthcare system spending was 19.7% of the nation’s gross domestic product (GDP) in 2020 (Montero et al., 2022). There are significant differences between healthcare spending in various geographic areas of the country. Factors like the frequency of healthcare visits, the number of diagnostic services provided, and hospitalization procedures increase costs. Studies indicate that Medicare beneficiaries who live in high-income areas receive approximately 60% more services than their counterparts (Montero et al., 2022). Individuals suffering from chronic conditions like heart disease, diabetes, and cancer regularly access healthcare leading to increased spending.

Privatization of healthcare is observed to contribute to the high cost of healthcare across the nation. In the US, most of the healthcare facilities are private with the government owning a few institutions. Although conservatives have long explained that privatization can address issues with access, cost, and quality of healthcare, long experience with private healthcare demonstrates different results. For instance, an increase in pharmaceutical companies has led to increased cost of medications making spending go high (Montero et al., 2022). Some medications like those required to treat cancer have high costs making people spend out-of-pocket costs to top up the purchase of these drugs. Privatization of healthcare has led to increased healthcare costs and monopoly leaving the people to suffer from increased access to healthcare.

The high cost of healthcare is a burden to many families and healthcare costs are observed to be a key factor in decisions about insurance coverage and health-seeking. The majority of affected individuals are adults because they regularly seek healthcare services. About half of the US adults have difficulty affording healthcare with four in ten adults observed to go without medical care in the last year due to cost (Montero et al., 2022). The cost of care limits people from filling prescriptions and further hinders the quality of life of those that depend on medications for survival and performance. Studies across the country indicate that about 41% of adults report having debts due to medical or dental bills (Montero et al., 2022). Regarding the aspect of health insurance, large shares of the uninsured Black and Hispanic adults make it difficult to afford essential services and drugs.


Quality of care is one of the most quoted principles of healthcare delivery and the top-most agenda for policy-makers at the national level. Quality refers to the extent to which the services provided to patients meet their expectations (Hannawa et al., 2022). At the international level, quality has gained attention due to its inclusion in the sustainable development goals (SDGs). The goal is to achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all (Hannawa et al., 2022). Healthcare quality can be described using six pillars that include safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. Healthcare providers can display clinical skills and expertise in aspects like communication which contributes to quality care.

Today’s healthcare system is competitive and the aspect of quality drives healthcare delivery to stay competitive in the business. Healthcare organizations must be innovative on how to provide good services to the patients and utilize evidence-based practices to improve patient outcomes. While delivering care, the providers must put the needs of the patient first and fully involve patients and their families in decision-making. Healthcare systems are of high quality when they achieve the overall goal of improved health, efficiency, and financial protection (Hannawa et al., 2022). The shift to quality care can also be attributed to the role of APNs and other healthcare professionals. These individuals are prepared to use critical thinking in making decisions that benefit patients. Using their positions in leadership, APNs are involved in making policies that align with the needs of patients including aspects of safety and cost of care. Improved quality in healthcare is essential to address the increasing burden of chronic diseases and the cost of services in today’s healthcare system.

Quality Measures, Evaluation, and Role Development

Quality measures are tools used to analyze procedures, outcomes, and patient perceptions that are key to determining the quality of care provided to patients. These outcomes are categorized into process, outcome, structural, and balancing measures (Jazieh, 2020). Process measures of quality reflect compliance with actions implemented to achieve the goals of projects. For example, the organization is measured on its ability to provide prophylactic therapy before surgery to patients undergoing colorectal surgery. Outcome measures indicate the patient’s healthcare status, for example, 30-day readmission rates. Structural measures indicate the capacity of the organization to include systems and processes to improve care (Jazieh, 2020). The last category is balancing measures that refer to the consequences of implementing a QI project that was not necessarily intended. For instance, an organization may display staff overload or additional financial costs that negatively impact cost and patient satisfaction.

Evaluation of quality measures is important to determine the extent to which the organization meets the needs of patients and its overall goals. One of the most frequently used tools for evaluation is patient satisfaction scores. This tool measures the patient’s perception of their hospital experience to allow meaningful comparison of hospitals on topics that are significant to consumers (Jazieh, 2020). Apart from the HCAHPs scores, hospitals can evaluate their quality using metrics like patient falls, employee satisfaction, and mortality rates. Advanced practice nurses assume an increasing role during the delivery of care to patients to ensure improved quality and safety. Through education, experience, and mentorship, APNs acquire essential skills that can be used to promote quality and safety (Joel, 2018). However, role development issues like role strain and role stress may affect how care is delivered and the achievement of required standards to provide quality care.

The role of the APN in healthcare is tied to quality and significant changes in the APN role may be observed without effective quality measures. Without quality measures, APNs may find it difficult to make positive changes in quality and determine the extent to which changes made achieve desired outcomes (Joel, 2018). Aspects of care like cost reduction and achievement of safety may get out of control if the APN does not get access to effective quality measures. APNs are tasked with providing comprehensive assessments that result in clinical decision-making that is safe and cost-effective (Joel, 2018). Lack of quality measures means that these individuals will have no baseline data for comparing outcomes and making decisions to improve quality.


Dawkins, B., Renwick, C., Ensor, T., Shinkins, B., Jayne, D., & Meads, D. (2020). What factors affect patients’ access to healthcare? Protocol for an overview of systematic reviews. Systematic Reviews9(1), 1-6.

Hannawa, A. F., Wu, A. W., Kolyada, A., Potemkina, A., & Donaldson, L. J. (2022). The aspects of healthcare quality that are important to health professionals and patients: A qualitative study. Patient Education and Counseling105(6), 1561-1570.

Joel, L.A., (2018). Advanced practice nursing. Essentials for role development (4th Ed.). Philadelphia, PA: F.A. Davis. [ISBN-13: 978-0-8036-6044-1]

Montero, A., Kearney, A., Hamel, L., & Brodie, M. (2022). Americans’ challenges with health care costs. Kaiser Family Foundation.

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