The Validity of “ Cheap , Fast , Good : Pick Any Two ” in Evaluating Healthcare Systems
1 . Introduction
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common aphorism is “ cheap , fast , good : pick any two ”. The presumption is that services ( or goods with a heavy service component , for instance in a restaurant ) will , at best , only manage to achieve two of these measurements . Thus , something cheap and fast will not be very good , while something good and cheap will not be delivered fast , or something fast and good will not be cheap . As long as consumers and providers are aware of this apparent conflict between these three forces , it is not difficult for either to focus on the two characteristics each values most highly , and then pursue those .
This idea of cheap , fast , good as limiting factors is not restricted to any one field , but as an identified concept , it shows up most prominently in project management . Stafford ( 2012 ) applied it to Information Technology in a discussion on outsourcing , while Maiorino ( 2017 ) applied it to payroll systems . Downing ( 1997 ) extends the idea to an “ iron triangle ” in his discussion of the U . S . army ’ s Cold War doctrine of tanks , where the focus was on firepower and armor , yet largely neglecting movement . In this context , it addresses a common problem , as tanks and other military vehicles need to balance offensive capability ( firepower , number of bombs , etc .), defensive capability ( armor , stealth , etc .), and movement ( a balance of speed , range , and power ). As with the concept of cheap , fast , and good , the idea is not to achieve all three , but to reach a level of balance between the three that corresponds to the desired role and mission . On a more quotidian level , there are numerous restaurants offering cheap food , served fast , but perhaps often at the expense of quality , as noted by Saunders , Saunders , and Middleton ( 2015 ). Health care systems are under similar constraints , as discussed by Beauchamp ( 2009 ), with the underlying reasoning that consumers , providers , legislators , and other involved parties should pick the two characteristics they desire , and aim to achieve those , with the understanding that this will bring at least some deficiency in the third area . With such a broad application , it is not surprising to see the quantity of health care research addressing various aspects of quality ( e . g . Cylus & Papanicolas , 2015 ; Groenewegen , Kerssens , Sixma , van der Eijk , & Boerma , 2005 ; Valentine , Bonsel , & Murray , 2007 ), cost ( e . g . Gelormino , Bambra , Spadea , Bellini , & Costa , 2011 ; Perkowski & Rodberg , 2016 ), and timeliness ( e . g . Carroll , Horn , Soderfeldt , James , & Malmberg , 1995 ; Jaakkimainen et al , 2014 ; OECD / European Union , 2016 ; OECD , 2017a ; Redaniel , Martin , Cawthorn , Wade , & Jeffreys , 2013 ; Viberga , Forsberga , Borowitz , & Moline , 2013 ). There are a few instances of quantitative research comparing multiple countries on two of these issues ( e . g . Al-Jazaeri et al , 2017 ; Bucci et al , 2016 ; Hadad , Hadad , & Simon-Tuval , 2013 ; Rechel et al , 2016 ; Sawamura , Sano , & Nakanishi , 2015 ; Stephens , Ledlow , Sach , & Reagan , 2017 ; Tandon et al , 2000 ; Varabyova & Schreyögg , 2013 ; Varkevisser , van der Geest , & Schut , 2010 ; von Wyl & Beck , 2016 ; Weaver et al , 2010 ), but these are largely limited to
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