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Health care

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For other uses, see Health care (disambiguation).
A modern hospital building of the United Kingdom's National Health Service in Norfolk. The UK operates a system of publicly-funded health care, free for everyone at the point of use.
Blood testing in a medical facility in Ethiopia.

Health care, or healthcare, is the treatment and management of illness, and the preservation of health through services offered by the medical, pharmaceutical, dental, clinical laboratory sciences (in vitro diagnostics), nursing, and allied health professions. Health care embraces all the goods and services designed to promote health, including “preventive, curative and palliative interventions, whether directed to individuals or to populations”.[1] The organised provision of such services may constitute a health care system. This can include specific governmental organizations such as, in the UK, the National Health Service or a cooperation across the National Health Service and Social Services as in Shared Care. Before the term health care became popular, English-speakers referred to medicine or to the health sector and spoke of the treatment and prevention of illness and disease.


Settings

Health care can encompass a wide number of settings - from the informal (house calls, emergency medicine at an accident spot) to settings like nursing homes or rest homes, to 'typical' medical settings like doctor's practices, clinics and hospitals.

Industry

Main article: Health care industry

The health care industry is considered an industry or profession which includes peoples' exercise of skill or judgment or the providing of a service related to the preservation or improvement of the health of individuals or the treatment or care of individuals who are injured, sick, disabled, or infirm. The delivery of modern health care depends on an expanding group of trained professionals coming together as an interdisciplinary team.[2][3]

Consuming just under 10 percent of gross domestic product of most developed nations, health care can form an enormous part of a country's economy. In 2003, health care costs paid to hospitals, physicians, nursing homes, diagnostic laboratories, pharmacies, medical device manufacturers and other components of the health care system, consumed 16.3 percent[4] of the GDP of the United States, the largest of any country in the world. For the United States, the health share of gross domestic product (GDP) is expected to hold steady in 2006 before resuming its historical upward trend, reaching 19.5 percent of GDP by 2016.[5] In 2001, for the OECD countries the average was 8.4 percent[6] with the United States (13.9%), Switzerland (10.9%), and Germany (10.7%) being the top three.

History

When considering the history of Universal Health Care and the giants of Canadian politics, T.C. Douglas surely stands at the forefront. Tommy Douglas was a remarkable Canadian whose contributions have helped to shape the great nation. Although he is most famous as the founding father of Medicare, the most advanced health-care system in the world, Douglas’ contributions to Saskatchewan and Canada were tremendous.

Tommy Clement Douglas was born on October 20, 1904 in Falkirk, Scotland. In 1911, Tommy, his mother and his sister moved to Winnipeg to join his father who had moved there the previous year. Shortly after settling in Winnipeg, Tommy was diagnosed with osteoarthritis in his right leg. Tommy’s family was not wealthy and subsequently his family could not pay for the best or most immediate treatment. The delay nearly cost Tommy his leg. This experience marked the beginning of Tommy’s quest for universal, public health care.

In 1961, In Saskatchewan, Canada, The North American Medical Establishment tried to defy Medicare, Douglas’s top priority project, and Saskatchewan politics became an intense battleground. This turbulent time was marked by the Doctor’s Strike as the physicians of the province protested socialized healthcare. However, the striking doctors were no match for Douglas. When the dust settled with the resolution of the strike, Medicare in Saskatchewan was born. Douglas showed Canada two things: that it was possible to develop and finance a universal Medicare system and that the medical profession could be confronted. Had Douglas not have made these first ground breaking steps, national Medicare would never have happened. This movement and political struggle helped pave the way for universal health care on a global scale. Since then, Canada's system of health care has been imitated and implemented in various countries around the world.

Systems

Main article: Health care systems
See also: Preventive medicine and Social medicine

A single-payer universal health care system will save money through reduced bureaucratic administration costs.[7] Social health insurance is where the whole population or most of the population is a member of a sickness insurance company. Most health services are provided by private enterprises which act as contractors, billing the government for patient care.[8] In almost every country with a government health care system a parallel private system is allowed to operate. This is sometimes referred to as two-tier health care. The scale, extent, and funding of these private systems is very variable.

A traditional view is that improvements in health result from advancements in medical science. The medical model of health focuses on the eradication of illness through diagnosis and effective treatment. In contrast, the social model of health places emphasis on changes that can be made in society and in people's own lifestyles to make the population healthier. It defines illness from the point of view of the individual's functioning within their society rather than by monitoring for changes in biological or physiological signs.[9]

WHO

Main article: World Health Organization
See also: Global health

The World Health Organization (WHO) is a specialised United Nations agency which acts as a coordinator and researcher for public health around the world. Established on 7 April 1948, and headquartered in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health Organization, which had been an agency of the League of Nations. The WHO's constitution states that its mission "is the attainment by all peoples of the highest possible level of health." Its major task is to combat disease, especially key infectious diseases, and to promote the general health of the peoples of the world. Examples of its work include years of fighting smallpox. In 1979 the WHO declared that the disease had been eradicated - the first disease in history to be completely eliminated by deliberate human design. The WHO is nearing success in developing vaccines against malaria and schistosomiasis and aims to eradicate polio within the next few years. The organization has already endorsed the world's first official HIV/AIDS Toolkit for Zimbabwe from October 3 2006, making it an international standard.[10]

The WHO is financed by contributions from member states and from donors. In recent years the WHO's work has involved more collaboration, currently around 80 such partnerships, with NGOs and the pharmaceutical industry, as well as with foundations such as the Bill and Melinda Gates Foundation and the Rockefeller Foundation. Voluntary contributions to the WHO from national and local governments, foundations and NGOs, other UN organizations, and the private sector (including pharmaceutical companies), now exceed that of assessed contributions (dues) from its 193 member nations.[11]

Health care by country

Main article: Health care systems

Template:Topic by country

Economics

Main article: Health care economics

Health care economics consists of a complicated relationship between a number of participants; the consumer, insurance companies (where they exist), employers, medical professionals, and various government entities. An essential feature of health care economics is the spreading of risk, since the cost of health care for catastrophic illness can be prohibitive. This risk may be spread by private insurance companies (who seek to make a profit), or by government involvement in the health care market. The health care market can suffer from a number of problems which are so severe as to be characterized by some as market failure.

  • Adverse selection in insurance markets occurs because those providing insurance wish to limit insurance payouts, thus providing a profit. In simple terms, those with poor health will apply for insurance, raising the cost of providing insurance; those with good health will find the cost of insurance too expensive, raising costs further. Private insurers are economically incentivized to spend substantial sums on investigating the health history of prospective clients and proving those in need to be uninsurable while charging higher premiums for unhealthy individuals, which they may not be able to afford in order to provide a "profit margin". [12][13]
  • Moral hazard in insurance markets occurs when the insured behave in a riskier manner than they would if they were not insured. This argument is significantly weakened when speaking of health care which becomes more prevalent with age for example, regardless of other factors.

Among the potential solutions posited by economists are:

  • Various forms of universal health insurance, such as requiring all citizens to purchase insurance, limiting the ability of insurance companies to deny insurance to individuals or vary price between individuals. Compulsory universal health insurance is a common thread, although there is no requirement that the insurance or medical services be provided by government, no accountability amongst insurers, and no protection against rising health insurance costs.
  • Decreased government regulation: Conservative Republican US Senator Bill Frist argued[14] that the free market will keep costs down, because individuals who have to pay for their own health care will make wiser decisions and not spend money on unneeded or inefficient care. However, as this cuts down on the routine maintenance of care and penalizes the afflicted who can least afford to pay for care, the overall health statistics of the country decline. The US currently (2007) has the most expensive health care of any OECD country and also has the highest percentage of costs paid privately with some of the worst health statistics in the free world.[15] This also foists more expensive "consumers" of the product on to the public sector.
Country Life expectancy Infant mortality rate Physicians per 1000 people Nurses per 1000 people Per capita expenditure on health (USD) Healthcare costs as a percent of GDP % of government revenue spent on health % of health costs paid by government % of health costs paid private insurance [16] % of health costs paid by consumer
Australia 80.5 5.0 2.47 9.71 2,519 9.5 17.7 67.5 7.4 21.8
Canada 80.5 5.0 2.14 9.95 2,669 9.9 16.7 87.9 12.6 6.8
France 79.5 4.0 3.37 7.24 2,981 10.1 14.2 76.3 12.6 7.4
Germany 80.0 4.0 3.37 9.72 3,204 11.1 17.6 78.2 8.8 10.5
Japan 82.5 3.0 1.98 7.79 2,662 7.9 16.8 81.0 0.4 17.2
Sweden 80.5 3.0 3.28 10.24 3,149 9.4 13.6 85.2 0.0 15.1
UK 79.5 5.0 2.30 12.12 2,428 8.0 15.8 85.7 0.0 14.4
USA 77.5 6.0 2.56 9.37 5,711 15.2 18.5 44.6 36.8 13.3

Most European systems are financed through a mix of public and private contributions, much like the United States, only costing less.[17] The majority of universal health care systems are funded primarily by tax revenue (e.g. Portugal[17]). Some nations, such as Germany, France[18] and Japan[19] employ a multi-payer system in which health care is funded by private and public contributions. In 2001 Canadians paid $2,163 per capita versus $4,887 U.S., according to the Los Angeles Times (also, see table above). According to Dr. Stephen Bezruchka, a senior lecturer in the School of Public Health at the University of Washington in Seattle, Canadians do better by every health care measure. According to a World Health Organization report published in 2003, life expectancy at birth in Canada is 79.8 years, versus 77.3 in the U.S.[20]

A distinction is also made between municipal and national healthcare funding. For example, one model is that the bulk of the healthcare is funded by the municipality, speciality healthcare is provided and possibly funded by a larger entity, such as a municipal co-operation board or the state, and the medications are paid by a state agency. No entirely private health care system exists, although the reform bill in Massachusetts attempts to make private health care more affordable while failing miserably and increasing costs for average families.

Politics

Main article: Health care politics

The politics of health care depends largely on which country one is in. Current concerns in England, for instance, revolve around the use of private finance initiatives to build hospitals or the excessive use of targets in cutting waiting lists. In Germany and France, concerns are more based on the rising cost of drugs to the governments. In Brazil, an important political issue is the breach of intellectual property rights, or patents, for the domestic manufacture of antiretroviral drugs used in the treatment of HIV/AIDS.

The South African government, whose population sets the record for HIV infections, came under pressure for its refusal to admit there is any connection with AIDS[21] because of the cost it would have involved. In the United States 12% to 16% of the citizens are still unable to afford health insurance. State boards and the Department of Health regulate inpatient care to reduce the national health care deficit. To tackle the problems of the perpetually increasing number of uninsured, and costs associated with the US health care system, President Barack Obama says he favors the creation of a universal health care system [22]. However, New York Times columnist Paul Krugman said that Obama's plan would not actually provide universal coverage.[23] (In contrast, Dennis Kucinich, an early candidate who did not get on the ballot, supported a single-payer system.) Factcheck.org said that Obama's predicted savings were exaggerated. [24]

Providers

Main article: Health care provider

A health care provider or health professional is an organization or person who delivers proper health care in a systematic way professionally to any individual in need of health care services. A health care provider could be government, the health care industry, a health care equipment company, an institution such as a hospital or medical laboratory, physicians, dentists, support staff, nurses, therapists, psychologists, pharmacists, chiropractors, and optometrists.

Research

See also: List of medical journals, List of pharmaceutical sciences journals, List of bioinformatics journals, and Medical literature

Top impact factor academic journals in the health car field include Health Affairs and Milbank Quarterly. New England Journal of Medicine, British Medical Journal and Journal of the American Medical Association are more general journals.

Biomedical research (or experimental medicine), in general simply known as medical research, is the basic research, applied research, or translational research conducted to aid the body of knowledge in the field of medicine. Medical research can be divided into two general categories: the evaluation of new treatments for both safety and efficacy in what are termed clinical trials, and all other research that contributes to the development of new treatments. The latter is termed preclinical research if its goal is specifically to elaborate knowledge for the development of new therapeutic strategies. A new paradigm to biomedical research is being termed translational research, which focuses on iterative feedback loops between the basic and clinical research domains to accelerate knowledge translation from the bedside to the bench, and back again.

See also

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Notes

  1. ^ World Health Organization Report. (2000). "Why do health systems matter?". WHO.
  2. ^ Princeton University. (2007). health profession. Retrieved June 17, 2007, from http://wordnet.princeton.edu/perl/webwn?s=health%20profession
  3. ^ United States Department of Labor. (2007, February 27). Health Care Industry Information. Retrieved June 17, 2007, from http://www.doleta.gov/BRG/Indprof/Health.cfm
  4. ^ From Centers for Medicare & Medicaid Services
  5. ^ "The Not So Short Introduction to Health Care in US", by Nainil C. Chheda, published in February 2007, Accessed February 26, 2007.
  6. ^ OECD data
  7. ^ Massachusetts Nursing Association. "Single Payer Health Care: A Nurses Guide to Single Payer Reform."
  8. ^ CBC Health Care Private verses Public
  9. ^ Bond J. & Bond S. (1994). Sociology and Health care. Churchill Livingstone. ISBN 0-443-04059-1.
  10. ^ Xinhua - English
  11. ^ "Implementation of budget resolutions" (PDF). World Health Organization. 1999-12-16. Retrieved 2007-06-20.
  12. ^ Michael Rothschild and Joseph Stiglitz, "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," Quarterly Journal of Economics, November 1976 (90:629-649) (known as the Rothschild-Stiglitz Model)
  13. ^ Paulo Belli, How Adverse Selection Affects the Health Insurance Market
  14. ^ William H. Frist, Shattuck Lecture: Health Care in the 21st Century, New England Journal of Medicine, 20 Jan 2005, 352(3):267
  15. ^ Core Health Indicators
  16. ^ OECD Health data 2007
  17. ^ a b Bentes M, Dias CM, Sakellarides C, Bankauskaite V. Health Care Systems in Transition: Portuagal. WHO are Regional Offices for Europe on behalf of the European Observatory on Health Systems and Policies, 2004.
  18. ^ Physicians for a National Health Program"International Health Systems".
  19. ^ Chua, Kao-Ping. "Single Payer 101". February 10, 2006.
  20. ^ Foreman, Judy (2004-02-23). "In Health, Canada Tops US; Our neighbors to the north live longer and pay less for care. The reasons why are being debated, but some cite the gap between rich and poor in the US". Los Angeles Times. Retrieved 2007-07-03.
  21. ^ BBC News: Controversy dogs Aids forum
  22. ^ The Time Has Come for Universal Health Care | U.S. Senator Barack Obama
  23. ^ Clinton, Obama, Insurance, By Paul Krugman, February 4, 2008.
  24. ^ Obama's Inflated Health Savings
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