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Health care

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For "The Office" television show episode, see Health Care (The Office).

Health care (or healthcare) i the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers. It refers to the work done in providing primary care, secondary care and tertiary care, as well as in public health.

Access to services by health care practitioners varies across countries, groups and individuals, largely influenced by social and economic conditions as well as the health policies in place. Countries and jurisdictions have different policies and plans in relation to the personal and population-based health care goals within their societies. Health care systems are organizations established to meet the health needs of target populations. Their exact configuration varies from country to country. In some countries and jurisdictions, health care planning is distributed among market participants, whereas in others planning is made more centrally among governments or other coordinating bodies. In all cases, according to the World Health Organization (WHO), a well-functioning health care system requires a robust financing mechanism; a well-trained and adequately-paid workforce; reliable information on which to base decisions and policies; and well maintained facilities and logistics to deliver quality medicines and technologies.[1]

Health care can form a significant part of a country's economy. In 2008, the health care industry consumed an average of 9.0 percent of the gross domestic product (GDP) across the most developed OECD countries.[2] The United States (16.0%), France (11.2%), and Switzerland (10.7%) were the top three spenders.

Health care is conventionally regarded as an important determinant in promoting the general health and wellbeing of peoples around the world. An example of this is the worldwide eradication of smallpox in 1980 - declared by the WHO as the first disease in human history to be completely eliminated by deliberate health care interventions.[3]

Health care delivery

See also: Health care providers
Primary care may be provided in community health centres.

The delivery of modern health care depends on groups of trained professionals and paraprofessionals coming together as interdisciplinary teams.[4][5] This includes professionals in medicine, nursing, dentistry and allied health, plus many others such as public health practitioners, community health workers and assistive personnel, who systematically provide personal and population-based preventive, curative and rehabilitative care services.

While the definitions of the various types of health care vary depending on the different cultural, political, organizational and disciplinary perspectives, there appears to be some consensus that primary care constitutes the first element of a continuing health care process, that may also include the provision of secondary and tertiary levels of care.[6]

Primary care

Main article: Primary care
See also: Primary health care
Medical train "Therapist Matvei Mudrov" in Khabarovsk, Russia

Primary care is the term for the health care services which play a central role in the local community. It refers to the work of health care professionals who act as a first point of consultation for all patients within the health care system.[6][7] Such a professional would usually be a primary care physician, such as a general practitioner or family physician. Depending on the locality, health system organization, and sometimes at the patient's discretion, they may see another health care professional first, such as a pharmacist, a nurse (such as in the United Kingdom), a clinical officer (such as in parts of Africa), or an Ayurvedic or other traditional medicine professional (such as in parts of Asia). Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.

Primary care involves the widest scope of health care, including all ages of patients, patients of all socioeconomic and geographic origins, patients seeking to maintain optimal health, and patients with all manner of acute and chronic physical, mental and social health issues, including multiple chronic diseases. Consequently, a primary care practitioner must possess a wide breadth of knowledge in many areas. Continuity is a key characteristic of primary care, as patients usually prefer to consult the same practitioner for routine check-ups and preventive care, health education, and every time they require an initial consultation about a new health problem. The International Classification of Primary Care (ICPC) is a standardized tool for understanding and analyzing information on interventions in primary care by the reason for the patient visit.[8]

Common chronic illnesses usually treated in primary care may include, for example: hypertension, diabetes, asthma, COPD, depression and anxiety, back pain, arthritis or thyroid dysfunction. Primary care also includes many basic maternal and child health care services, such as family planning services and vaccinations.

In context of global population ageing, with increasing numbers of older adults at greater risk of chonic non-communicable diseases, rapidly increasing demand for primary care services is expected around the world, in both developed and developing countries.[9][10] The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary health care strategy.[6]

Secondary care

Secondary care is the health care services provided by medical specialists and other health professionals who generally do not have first contact with patients, for example, cardiologists, urologists and dermatologists.

It includes acute care: necessary treatment for a short period of time for a brief but serious illness, injury or other health condition, such as in a hospital emergency department. It also includes skilled attendance during childbirth, intensive care, and medical imaging services.

The "secondary care" is sometimes used synonymously with "hospital care". However many secondary care providers do not necessarily work in hospitals, such as psychiatrists or physiotherapists, and some primary care services are delivered within hospitals. Depending on the organization and policies of the national health system, patients may be required to see a primary care provider for a referral before they can access secondary care.

For example in the United States, which operates under a mixed market health care system, some physicians might voluntarily limit their practice to secondary care by requiring patients to see a primary care provider first, or this restriction may be imposed under the terms of the payment agreements in private/group health insurance plans. In other cases medical specialists may see patients without a referral, and patients may decide whether self-referral is preferred.

In the United Kingdom and Canada, patient self-referral to a medical specialist for secondary care is rare as prior referral from another physician (either a primary care physician or another specialist) is considered necessary, regardless of whether the funding is from private insurance schemes or national health insurance.

Allied health professionals, such as occupational therapists, speech therapists, and dietitians, also generally work in secondary care, accessed through either patient self-referral or through physician referral.

Tertiary care

The National Hospital for Neurology and Neurosurgery in London, United Kingdom is a specialist neurological hospital.
See also: Medicine

Tertiary care is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.[11]

Examples of tertiary care services are cancer management, neurosurgery, cardiac surgery, plastic surgery, treatment for severe burns, advanced neonatology services, palliative, and other complex medical and surgical interventions.[12]

Quaternary care

The term quaternary care is also used sometimes as an extension of tertiary care in reference to medicine of advanced levels which are highly specialized and not widely accessed. Experimental medicine and some types of uncommon diagnostic or surgical procedures are considered quaternary care. These services are usually only offered in a limited number of regional or national health care centres.[12][13]

Home and community care

See also: Public health

Many types of health care interventions are delivered outside of health facilities. They include many interventions of public health interest, such as food safety surveillance, distribution of condoms and needle-exchange programmes for the prevention of transmissible diseases.

They also include the services of professionals in residential and community settings in support of self care, home care, long-term care, assisted living, treatment for substance use disorders, and other types of health and social care services.

For general descriptions of health care financing and delivery systems by country, please see Health care system

Health care extends beyond the delivery of services to patients, encompassing many related sectors, and set within a bigger picture of financing and governance structures.

Health care industry

See also: Health care industry and Health economics
A group of Chilean 'Damas de Rojo' volunteering at their local hospital.

The health care industry incorporates several sectors that are dedicated to providing health care services and products. As a basic framework for defining the sector, the United Nations' International Standard Industrial Classification categorizes health care as generally consisting of hospital activities, medical and dental practice activities, and "other human health activities". The last class involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics, residential health facilites, or other allied health professions, e.g. in the field of optometry, hydrotherapy, medical massage, yoga therapy, music therapy, occupational therapy, speech therapy, chiropody, homeopathy, chiropractics, acupuncture, etc.[14]

In addition, according to industry and market classifications, such as the Global Industry Classification Standard and the Industry Classification Benchmark, health care includes many categories of medical equipment, instruments and services as well as biotechnology, diagnostic laboratories and substances, and drug manufacturing and delivery.

For example, pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States.[15][16] The United States dominates the biopharmaceutical field, accounting for three-quarters of the world’s biotechnology revenues.[17][15]

Health care research

See also: List of medical journals and List of health care journals

The quantity and quality of many health care interventions are improved through the results of science, such as advanced through the medical model of health which focuses on the eradication of illness through diagnosis and effective treatment. Many important advances have been made through health research, including biomedical research and pharmaceutical research. They form the basis of evidence-based medicine and evidence-based practice in health care delivery.

For example, in terms of pharmaceutical research and development spending, Europe spends a little less than the United States (€22.50bn compared to €27.05bn in 2006). The United States accounts for 80% of the world's research and development spending in biotechnology.[15][17]

In addition, the results of health services research can lead to greater efficiency and equitable delivery of health care interventions, as advanced through the social model of health and disability, which emphasizes the societal changes that can be made to make population healthiers.[18] Results from health services research often form the basis of evidence-based policy in health care systems.

Health care financing

See also: Health care system, Health policy, and Universal health care
For descriptions of health care financing by country, please see Health care system and Universal health care

There are generally five primary methods of funding health care systems:[19]

  1. general taxation to the state, county or municipality
  2. social health insurance
  3. voluntary or private health insurance
  4. out-of-pocket payments
  5. donations to health charities

In most countries, the financing of health care services features a mix of all five models, but the exact distribution varies across countries and over time within countries. In all countries and jurisdictions, there are many topics in the politics and evidence that can influence the decision of a government, private sector business or other group to adopt a specific health policy regarding the financing structure.

For example, social health insurance is where a nation's entire population is eligible for health care coverage, and this coverage and the services provided are regulated. In almost every jurisdiction with a government-funded health care system, a parallel private, and usually for-profit, system is allowed to operate. This is sometimes referred to as two-tier health care or universal health care.

Health care administration and regulation

See also: Healthcare provider requisites

The management and administration of health care is another sector vital to the delivery of health care services. In particular, the practice of health professionals and operation of health care institutions is typically regulated by national or state/provincial authorities through appropriate regulatory bodies for purposes of quality assurance.[20] Most countries have credentialing staff in regulatory boards or health departments who document the certification or licensing of health workers and their work history.[21]

Systems by country

Main article: Health care system

United States

See also: Health care reform in the United States
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The United States currently operates under a mixed market health care system. Government sources (federal, state, and local) account for 45% of U.S. health care expenditures.[22] Private sources account for the remainder of costs, with 38% of people receiving health coverage through their employers and 17% arising from other private payment such as private insurance and out-of-pocket co-pays. Opponents of government intervention into the market generally believe that such intervention distorts pricing as government agents would be operating outside of the corporate model and the principles of market discipline; they have less short and medium-term incentives than private agents to make purchases that can generate revenues and avoid bankruptcy.[citation needed] Health system reform in the United States usually focuses around three suggested systems, with proposals currently underway to integrate these systems in various ways to provide a number of health care options.[citation needed] First is single-payer, a term meant to describe a single agency managing a single system, as found in most modernized countries as well as some states and municipalities within the United States. Second are employer or individual insurance mandates, with which the state of Massachusetts has experimented. Finally, there is consumer-driven health, in which systems, consumers, and patients have more control of how they access care. This is argued[by whom?] to provide a greater incentive to find cost-saving health care approaches. Critics of consumer-driven health say that it would benefit the healthy but be insufficient for the chronically sick, much as the current system operates.[citation needed] Over the past thirty years, most of the nation's health care has moved from the second model operating with not-for-profit institutions to the third model operating with for-profit institutions; the greater problems with this approach have been the gradual deregulation of HMOs resulting in fewer of the promised choices for consumers, and the steady increase in consumer costs that have marginalized consumers and burdened states with excessive urgent health care costs that are avoided when consumers actually have adequate access to preventive health care.[citation needed]

A few states have taken serious steps toward universal health care coverage, most notably Minnesota, Massachusetts and Connecticut, with recent examples being the Massachusetts 2006 Health Reform Statute[23] and Connecticut's SustiNet plan to provide quality, affordable health care to state residents.[24]

The Patient Protection and Affordable Care Act (Public Law 111-148) was signed into law by President Barack Obama on March 23, 2010. Along with the Health Care and Education Reconciliation Act of 2010 (signed March 30), the Act is a product of the health care reform efforts of the Democratic 111th Congress and the Obama administration. The law includes health-related provisions to take effect over the next four years, including expanding Medicaid eligibility for people making up to 133% of the federal poverty level (FPL),[25] subsidizing insurance premiums for people making up to 400% of the FPL ($88,000 for family of 4 in 2010) so their maximum "out-of-pocket" payment for annual premiums will be on sliding scale from 2% to 9.8% of income,[26][27] providing incentives for businesses to provide health care benefits, prohibiting denial of coverage and denial of claims based on pre-existing conditions, establishing health insurance exchanges, prohibiting insurers from establishing annual coverage caps, and support for medical research.

United Kingdom

Main article: Healthcare in the United Kingdom

Each of the Countries of the United Kingdom has a National Health Service that provides public healthcare to all UK permanent residents that is free at the point of need and paid for from general taxation. However private healthcare companies are free to operate alongside the public one. Since health is a devolved matter, considerable differences are developing between the systems in each of the countries.[28]

Canada

Main article: Health care in Canada

In 1984, the Canada Health Act was passed, which guarantees access to primary and other health care services for all citizens, and prohibits extra billing by doctors on patients while at the same time billing the public insurance system. In 1999, the prime minister and most premiers reaffirmed in the Social Union Framework Agreement that they are committed to health care that has "comprehensiveness, universality, portability, public administration and accessibility."[29] The system is for the most part publicly funded, with most services provided through publicly administered hospitals or privately operating practitioners.

Guinea

See also: Health care in Guinea

Guinea has been reorganizing its health system since the Bamako Initiative of 1987 formally promoted community-based methods of increasing accessibility of primary health care to the population, including community ownership and local budgeting, resulting in more efficient and equitable provision of drugs and other essential health care resources.[30]

In June 2011, the Guinean government announced the establishment of an air solidarity levy on all flights taking off from national soil, with funds going to UNITAID to support expanded access to treatment for HIV/AIDS, tuberculosis and malaria.[31] Guinea is among the growing number of countries and development partners using market-based transactions taxes and other innovative financing mechanisms to expand financing options for health care in resource-limited settings.

See also

Notes

  1. ^ World Health Organization. Health systems. Geneva.
  2. ^ OECD data
  3. ^ World Health Organization. Anniversary of smallpox eradication. Geneva, 18 June 2010.
  4. ^ Princeton University. (2007). Health profession. Retrieved June 17, 2007, from Princeton University[dead link]
  5. ^ United States Department of Labor. Employment and Training Administration: Health care. Retrieved June 24, 2011.
  6. ^ World Health Organization. Definition of Terms. Accessed 24 June 2011.
  7. ^ World Health Organiztion. International Classification of Primary Care, Second edition (ICPC-2). Geneva. Accessed 24 June 2011.
  8. ^ World Health Organization. Ageing and life course: Our ageing world. Geneva. Accessed 24 June 2011.
  9. ^ Simmons J. Primary Care Needs New Innovations to Meet Growing Demands. HealthLeaders Media, May 27, 2009.
  10. ^ Johns Hopkins Medicine. Patient Care: Tertiary Care Definition. Accessed 27 June 2011.
  11. ^ a b Emory University. School of Medicine. Accessed 27 June 2011.
  12. ^ Alberta Rural Physician Action Plan. Levels of Care. Accessed 27 June 2011.
  13. ^ United Nations. International Standard Industrial Classification of All Economic Activities, Rev.3. New York.
  14. ^ a b c "The Pharmaceutical Industry in Figures" (pdf). European Federation of Pharmaceutical Industries and Associations. 2007. Retrieved February 15, 2010.
  15. ^ "2008 Annual Report" (PDF). Pharmaceutical Research and Manufacturers of America. Retrieved February 15, 2010.
  16. ^ a b "Europe's competitiveness". European Federation of Pharmaceutical Industries and Associations. Retrieved February 15, 2010.
  17. ^ Bond J. & Bond S. (1994). Sociology and Health Care. Churchill Livingstone. ISBN 0-443-04059-1.
  18. ^ World Health Organization. "Regional Overview of Social Health Insurance in South-East Asia.' and "Overview of Health Care Financing." Retrieved August 18, 2006.
  19. ^ World Health Organization, 2003. Quality and accreditation in health care services. Geneva http://www.who.int/hrh/documents/en/quality_accreditation.pdf
  20. ^ Tulenko et al., "Framework and measurement issues for monitoring entry into the health workforce." Handbook on monitoring and evaluation of human resources for health. Geneva, World Health Organization, 2009.
  21. ^ CMS Annual Statistics, United States Department of Health and Human Services
  22. ^ About.com's Pros & Cons of Massachusetts' Mandatory Health Insurance Program
  23. ^ http://www.aarp.org/states/ct/advocacy/articles/in_historic_vote_legislature_overrides_sustinet_veto.html
  24. ^ "5 key things to remember about health care reform". CNN. March 25, 2010.
  25. ^ "Policies to Improve Affordability and Accountability". The White House.
  26. ^ "Health Care Reform Bill 101". The Christian Science Monitor.
  27. ^ NHS now four different systems BBC January 2, 2008
  28. ^ Government of Canada, Social Union, News Release, "A Framework to Improve the Social Union for Canadians: An Agreement between the Government of Canada and the Governments of the Provinces and Territories, February 4, 1999." Retrieved 20 December 2006.
  29. ^ Knippenberg R et al. "Implementation of the Bamako Initiative: strategies in Benin and Guinea." Int J Health Plann Manage. 1997 Jun;12 Suppl 1:S29-47.
  30. ^ UNITAID. Republic of Guinea Introduces Air Solidarity Levy to Fight AIDS, TB and Malaria. Accessed 5 July 2011.
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