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All too often in scholarly publications, two questions typically go unanswered – so what and who cares? Stated in less crass terms, what difference does a particular publication make and to what extent are the thoughts and ideas of the authors used in a way that organizations and the people who populate then are better off? It is common practice for academics to be rewarded for writing to other academics in arcane journals in prose that is convoluted at best and frequently recycles old ideas or seeks to reaffirm the findings of others. In other words, a large part of traditional academic literature fails both tests.
Virtually every health system in the world is wrestling with the multifaceted question of how to most effectively reform their system in order to provide care to ever-growing numbers of people and simultaneously try to keep overall costs under control. In most nations, this dyad is complicated by the addition of a third critical element – quality. In his book, Medicine's Dilemmas: Infinite Need Versus Finite Resources (1994), Dr. William Kissick speaks clearly about the presence of the Iron Triangle in every health system. That triangle has at its vertices the elements of cost, quality, and access. Dr. Kissick makes the point that these three elements must be balanced in order for the health system to optimally function. For example, it is exceedingly unlikely if not totally impossible to significantly increase access to health services and hold quality constant without increasing cost. Alternatively, reducing cost must be accompanied by either reducing access or cutting back on quality.