The Iron Triangle

"The Iron Triangle" is a term coined to describe the relationship between cost, quality, and access in all sorts of institutions such as policy making, healthcare, and businesses. You can't affect one aspect without affecting the other two aspects, it is a concept full of trade-offs. Being that the relationship is reciprocal it is difficult to have any significant change in either cost, quality, or access.The problem with this is that they are in competition with each other.
For example, to make healthcare more affordable would increase access to it but most likely decrease the quality of care. You might increase the quality of the healthcare, but that will increase costs and limit access to it. You could also increase access to the healthcare, but that will cost money, or result in lower quality care.

Quality, Cost, and Access in Health Care:

Cost, Quality, and Access: The Iron Triangle of Trade-offs

"Health policy analysts commonly refer to an “iron triangle” of health care. The three vertices of the triangle are the cost, quality, and accessibility of care. The “iron triangle” means that, in equilibrium, increasing the performance of the health care system along any one of these dimensions can compromise one or both of the other dimensions, regardless of the amount that is spent on health care. Such tradeoffs are not always required, of course. For example, tying payments to health care providers to the quality of services provided could improve providers’ incentives to contain costs and improve quality. Better quality also could be achieved at less cost by reducing unnecessary services and managing consumers with chronic conditions more cost-effectively. Competition has an important role to play in accomplishing these objectives."

Skepticisms of the Iron Triangle in Healthcare

Author and family physician David Liu, M.D. wrote of the Iron Triangle as not a law binding the healthcare system but an observation that the healthcare system is currently stuck in and can be broken. He compares healthcare to notable inventions in history, such as commercial flight and computers. When both first existed they were unaffordable to the public which restricted access and were not of the best or safest quality. They each went through their own "Iron Triangle" phases where cost, quality, and access fluctuated but ultimately here we are with the most most affordable, widely accessible, and powerful forms of computing and transportation in the history of mankind. Dr. Liu's theory is that healthcare hasn't reached it's peak and we just need future doctors, insurers, entrepreneurs, and patients to discover what these changes need to be made to achieve the maximum balance between the three.

Article: Health Care Balancing Act

Article (PDF):



Lauren Johnson