Affordable Care 

Healthcare expenditures in the U.S. are unmatched by any country in the world. Unfortunately, this spending has not resulted in better health for Americans, and in general, the U.S. underperforms compared to other industrialized nations in terms of mortality, patient satisfaction, access to care, and quality of healthcare. Our healthcare spending continues to increase at an unsustainable rate of seven percent per year, and is largely focused on treating acute and chronic illness rather than promoting health and preventing illness and disability.

The National Quality Strategy emphasizes the need to make quality care more affordable for people, families, employers, and governments by focusing on two goals:

  1. Ensuring affordable and accessible high-quality healthcare for people, families, employers, and governments.
  2. Supporting and enabling communities to ensure accessible, high-quality care while reducing unnecessary costs.

Many opportunities exist to address affordability, lower healthcare costs, thereby increasing value and creating a less wasteful healthcare system. In 2012, the Institute of Medicine noted that six factors contributing to excess healthcare costs – unnecessary services, inefficiently delivered services, excess administration costs, prices that are too high, missed prevention opportunities, and fraud – account for approximately $750 billion in spending. Through its endorsement projects, its membership, and its partnerships, NQF is working to address affordability by elevating these issues to the forefront of policy discussions.

Related NQF Work

  • Measuring Affordable Care
    This project will examine measurement concepts for affordability from the patient perspective. This work will focus on understanding how patients use cost data to provide a pathway to more effective patient-oriented measures.
  • Linking Cost and Quality Measures
    This project will explore current approaches to measuring efficiency and develop best practices for combining cost measures with clinical quality measures to improve efficiency of care.
  • Cost and Resource Use Measures
    This project began in 2012 and is aimed at expanding NQF’s portfolio of cost and resource use measures, with total cost as well as condition-specific measures.
  • All-Cause Readmissions Measures
    In 2012, NQF endorsed two measures that address all-cause unplanned readmissions in hospitals – an area of healthcare targeted for improvement given national imperatives to make healthcare safer, more affordable, and keep people healthy. 
    Press Release | Endorsement Summary 
  •  NQF's First Cost and Resource Use Endorsement Project
    In 2010, NQF began a project to endorse measures of healthcare resource use and costs resulting in eight endorsed measures. These measures focus on diabetes, asthma, chronic obstructive pulmonary disease, hip/knee replacement, pneumonia, and cardiovascular care costs as well as total costs, providing vital data on how resources are used in these particular areas of care.
  • 2012 Measure Gap Analysis Report
    NQF’s 2012 analysis of measure gaps identified gaps related to affordability, including patient-reported outcomes to assess the cost and burden of healthcare; disparities in access and affordability; transparency of pricing; and overuse, waste, and inappropriate care. Please see page 23 of this report for more detail about measure gaps and the use of affordability-related measures.

Recommended Reads

Yegian JM, Dardess P, Shannon M et al. Engaged patients will need comparative physician-level quality data and information about their out-of-pocket costs. Health Aff. 2013, 32(2):328-337.

Squires. The road not taken: the cost of 30 years of unsustainable health spending growth in the United States. The Commonwealth Fund Blog, March 21, 2013.

Consumer Beliefs and Use of Information about Health Care Cost, Resource Use, and Value: Findings from Consumer Focus Groups. American Institutes for Research. Publisher: Robert Wood Johnson Foundation Published 10/1/2012

Available at

Physicians' Views of Comparative Information on Costs and Resource Use: Findings and Implications for Report Developers. American Institutes for Research Publisher: Robert Wood Johnson Foundation Published 10/1/2012

Available at

Tell us what you think

What issues related to affordability are you working on? What measures are you using? We want to hear about it.

Please email us about your own efforts to improve affordability at 



NQF Resources

The Field Guide is an online resource designed to help you easily access NQF resources.   

Find Measures

Use NQF's Quality Positioning System (QPS) to find measures related to Affordable Care.

Find measures now! 

Learn from Others

Use NQF's Online Action Registry (OAR) to learn about other efforts in the field to improve affordability. 

Find actions now!