Levels of health care

In the curative domain there are various forms of medical practice. They may be thought of generally as forming a pyramidal structure, with three tiers representing increasing degrees of specialization and technical sophistication but catering to diminishing numbers of patients as they are filtered out of the system at a lower level. Only those patients who require special attention either for diagnosis or treatment should reach the second (advisory) or third (specialized treatment) tiers where the cost per item of service becomes increasingly higher. The first level represents primary health care, or first contact care, at which patients have their initial contact with the health-care system. Primary health care is an integral part of a country’s health maintenance system, of which it forms the largest and most important part. As described in the declaration of Alma-Ata, primary health care should be “based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development.” Primary health care in the developed countries is usually the province of a medically qualified physician; in the developing countries first contact care is often provided by nonmedically qualified personnel. The vast majority of patients can be fully dealt with at the primary level. Those who cannot are referred to the second tier (secondary health care, or the referral services) for the opinion of a consultant with specialized knowledge or for X-ray examinations and special tests. Secondary health care often requires the technology offered by a local or regional hospital. Increasingly, however, the radiological and laboratory services provided by hospitals are available directly to the family doctor, thus improving his service to ... (300 of 16486 words)

Encyclopedia of Public Health: Access To Health Services Top

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Rural environments present unique challenges for health care access. There are often shortages of medical personnel in rural areas, as well as transportation and distance barriers to care and an increasing economic destabilization of rural health care services. Since the mid-twentieth century, physicians have favored urban and suburban practice locations over rural areas. Physicians often need lucrative practices to repay high education debts, and they have been trained to use costly new technologies in diagnosis and treatment. Rural practice locations typically generate lower income for the physician and have fewer and older technology resources than urban and suburban locations. Modern medical school graduates are rarely well

Emergency medical services in such areas are scattered over great distances and often staffed . and the entire community is left with no access to urgent or emergency care. Primary care may be provided by nurse practitioners. and the poor with no access to hospital inpatient care. increasing costs. rural residents must often travel great distances to access more costly and complex levels of care. yet the time expended is the same. this strategy often fails and the hospital must close. The urban nurse will be reimbursed for five visits and the rural nurse for two. mobile clinics. As costs increase. Small rural health care providers. People with financial resources and the ability to travel tend to use distant urban centers even for less complex needs. and in patient's homes. Advances in medical technology. and market forces contribute to the economic destabilization of many rural health care systems. advanced trauma care. Physician shortages are most visible in primary prevention. In addition. equipment. Such resources are economically viable only in hospitals and surgical centers with high volumes of patients. churches. while a nurse in a rural setting may visit only one or two patients.. and treatment. Low population density and greater travel times and barriers in rural areas affect service availability. artery repair. spending most of the time traveling. rural communities suffer chronic physician shortages. Home-based services in rural areas must. the disabled. Public health systems and an array of alternative primarycare providers often fill in the gaps. Accessing complex care in urban medical centers often generates a patient perception that all rural hospital care is of lower quality. especially home-based or mobile services. and facilities. such as health departments. Neither of these populations generates reimbursements adequate to cover the costs of services. the fewer the available health services and the longer the travel distances to access these services. The majority of patients admitted to rural hospitals are either too frail to withstand travel to distant hospitals or cannot afford either the travel or the cost of care in urban areas. the ability of people to get to those services. immunizations) situated in central locations. The lower the population density and the larger the area over which the population is distributed. Closures leave the very old.prepared to practice in rural environments. diagnosis. family planning. access public or charitable subsidization in order to remain economically viable. public and private insurers must struggle to control their expenditures. Price controls most severely affect rural health systems.g. Many rural hospitals and providers have diversified services to increase revenues. or schools. for services include the minimum estimated cost of providing each service. Specialty physician services (such as psychiatry or dermatology) may also be available through intermittent clinics in local facilities. and other complex procedures require specialized medical teams. Coronary bypass surgery. cannot afford the equipment and personnel necessary to treat the entire array of modern disease and injury. physician assistants. Practice locations include publicly or charitably subsidized comprehensive primary-care centers or categorical service clinics (e. especially hospitals. the cost per unit of service is often many times greater than in urban locations. the area suffers from the significant loss of employment. prenatal care. and the economic viability of the services. Consequently. Reduced fees and the refusal of insurers to pay for care often destabilize private professional practices in rural areas. Consequently. or fee scales. Because of the distances between service locations or patient residences. or home-health nurses. However. Prices. a home health nurse may visit five patients in a morning within an urban apartment building. therefore. Lower population density also means a lower volume of patients and less provider income. For example. leading to greater shortages of personnel.

reflecting the different cultural values and mores of those societies. and alternative practitioners) and whether they are practicing as individuals. Prevention. Traditional Medical Practice in America For the first century of the republic. ISAAC. doctors' offices. The financing of care involves who pays for medical services (for example. Germany. may take longer to arrive than in other areas. HEATHER REED US History Encyclopedia: Health Care Top Home > Library > History. the rise of "minimally invasive" surgery a century later contributed to the movement of many surgical procedures out of hospitals and into doctors' offices and other outpatient locations. Canada. France. self-pay. or in massive corporate organizations. Politics & Society > US History Encyclopedia The term "health care system" refers to a country's system of delivering services for the prevention and treatment of disease and for the promotion of physical and mental well-being. and Great Britain follow similar medical practices. Thus. The organization of care refers to such issues as who gives care (for example. and delivered. Poor roads or geographic barriers. Medicare. are beginning to use telemedicine to improve access for primary care and certain specialty care. private insurance. in large groups. urban. Emergency care for severe trauma or major acute illnesses. More remote areas with the capacity to pay for the technology. magnify the effects of distance. the rise of modern surgery in the late nineteenth and early twentieth centuries helped create the modern hospital in the United States and helped lead to the concentration of so many medical and surgical services in hospital settings. health care systems reflect the changing scientific and technologic nature of medical practice. such as mountains or rivers. For instance. or suburban locations). like medical knowledge and medical practice. in hospitals. However. specialist physicians. in small groups. In part. such as psychiatry and dermatology. almost all physicians engaged in "general practice"—the provision of medical and surgical care for all diseases and for all patients." whereby they practiced by themselves without . or various types of outpatient clinics. The delivery of care refers to how and where medical services are provided (for example. such as stroke and heart attack. causing increased morbidity and mortality. Of particular interest to a health care system is how medical care is organized. but the health care systems of these nations vary considerably. Poverty and Health. physicians in the United States. such as western Kansas. Health care systems. Prenatal Care. financed. regardless of sex and age.with volunteers who have other jobs. doctors engaged in "solo practice. nurses. (SEE ALSO: Immunizations. A country's health care system also reflects in part the culture and values of that society. Primary Care. Public Health Nursing) — SUSAN W. are not fixed but are continually evolving. or Medicaid) and how much money is spent on medical care. Typically. and in rural. Migrant Workers. primary care physicians.

The location of care moved to doctors' offices for routine illnesses and to hospitals for surgery. or pharmacy. but already 80 percent of physicians resided in cities or large towns. specialty medicine was already becoming prominent. Since most hospitals were concentrated in cities and large towns. most physicians resided in rural settings. Reflecting the rural makeup of the country. and doctors often received payment in kind—a chicken or box of fruit rather than money. where larger concentrations of patients could be found. there were 661 hospitals in the United States containing in aggregate about 30. the technologic capacity and cultural authority of physicians in the United States began to escalate. In the last quarter of the nineteenth century and first quarter of the twentieth century. House calls were common. Payment was on the "fee-for-service" basis.000 beds. a "two-tiered" system of health care officially existed—private rooms in hospitals for paying patients. safer childbirth. By 1930. doctors were increasingly found in larger metropolises. homeopaths. and many effective new drugs and operations—the cultural authority of doctors continued to grow.partners. physician earned 2½ times the income of the average worker. the number of acute care hospitals had increased to around 7.S. vitamins. Residency programs in the clinical specialties had been created. Before World War II (1939–1945). By 1940. Medicine at this time was not an easy way for an individual to earn a living. Doctors would give patients a bill. Indeed. In many hospitals and clinics. particularly in the South. fee-for-service practice. and large wards for indigent patients where as many as thirty or forty "charity" patients would be housed together in one wide open room. competition to "regular medicine" from alternative healers had markedly slackened. childbirth. population was still 50 percent rural. antiseizure medications. and most Americans thought of consulting a doctor if they needed medical services. Table 1 Specialization in Medicine American Board of Ophthalmology American Board of Pediatrics 191 6 193 3 . the U. Doctors' offices were typically at their homes or farms.S. and faith healers. and by 1940 formal certifying boards in the major clinical specialties had been established. However.000. In the 1920s. and the average U. and together they contained about one million beds. Many physicians could not be kept busy practicing medicine. and health care was not yet considered a fundamental right. As one manifestation of this phenomenon. hormones. and it was common for doctors to have a second business like a farm.) Most physicians continued in solo. and major medical problems. on average. Doctors also experienced vigorous competition for patients from a variety of alternative or lay healers like Thomsonians." In 1875. Competition for patients from alternative healers diminished. Physician income. fueled by the revolution in medical science (particularly the rise of bacteriology and modern surgery). Decade by decade. about 75 to 80 percent of doctors continued to engage in general practice. the hospital came to be considered the "doctor's workshop. fueled by the growing results of scientific research and the resultant transformation of medical practice—antibiotics. was not high. general store. hospital wards were segregated by race. and patients would pay out of pocket. (Some medical specialists earned much more.

In 1900. Most Americans now faced the . were developed. Equally impressive therapeutic procedures came into use. and heart attacks had replaced infections as the major causes of death. such as automated chemistry analyzers. antihypertensive drugs. hip replacements. computerized tomography. and the major causes of death each year were various infections. corticosteroids. kidney dialysis machines. and a variety of organ transplantations. and by the end of the century life expectancy in the United States had increased about 30 years from that of 1900. such as newer and more powerful antibiotics. mechanical ventilators. 1945–1985 The four decades following World War II witnessed even more extraordinary advances in the ability of medical care to prevent and relieve suffering. average life expectancy in the United States was forty-seven years.Specialization in Medicine American Board of Radiology American Board of Psychiatry and Neurology American Board of Orthopedic Surgery 193 4 193 4 193 4 American Board of Colon and Rectal 193 Surgery 4 American Board of Urology American Board of Pathology American Board of Internal Medicine American Board of Anesthesiology American Board of Plastic Surgery American Board of Surgery American Board of Neurological Surgery 193 5 193 6 193 6 193 7 193 7 193 7 194 0 The Transformation of Health Care. stroke. Powerful diagnostic tools were developed. New vaccines. By midcentury. and nuclear magnetic resonance imaging. most notably the polio vaccine. chronic diseases such as cancer. immunosuppressants. openheart surgery. radioimmunoassays.

that number had climbed to around 48 million. In the 1940s. Public opinion polls of the early 1980s revealed that 60 percent of the population worried about health care costs. Employers found their competitiveness in the global market to be compromised. stunned many Americans by pointing out that U. The egalitarian spirit of post–World War II society resulted in the new view that health care was a fundamental right of all citizens. instead. this meant unprecedented financial prosperity and minimal interference by payers in medical decision-making. hospitals. by 1960. For providers of medical care. Before the war." which was estimated to be two to four times as much as in other Western industrialized nations. The increasingly complicated U. Third-party payers of this era continued to reimburse physicians and hospitals on a fee-for-service basis. health care system became inundated with paperwork and "red tape. (When President Bill Clinton assumed office in 1993. most American physicians were still general practitioners. 85 to 90 percent of medical graduates were choosing careers in specialty or subspecialty medicine. while president of Chrysler in the late 1970s. 1950s. others argued that there was an overemphasis on disease treatment and a relative neglect of disease prevention and health promotion.S. Millions of Americans became unwillingly tied to their employers. the most critical problem of the health care system was soaring costs. Table 2 . these problems seemed even more insurmountable. and health care costs rose from 6 percent to 9 percent of the country's gross domestic product (GDP). unable to switch to a better job because of the loss of health care benefits if they did so.) Many patients and health policy experts complained of the fragmentation of services that resulted from increasing specialization. When he left office in 2001. however. automobile companies were spending more per car on health premiums for workers than for the steel that went into the automobiles. In the fifteen years following the passage of Medicare and Medicaid. This change in attitude was financed by the rise of "third-party payers" that brought more and more Americans into the health care system. In 1965.problem of helping their parents or grandparents cope with Alzheimer's disease or cancer rather than that of standing by helplessly watching their children suffocate to death from diphtheria. Despite these accomplishments. resulted in profound changes in the country's health care delivery system. compared with only 10 percent who worried about the quality of care. the number of uninsured Americans was estimated at 40 million. And the scientific and technological advances of medicine created a host of unprecedented ethical issues: the meaning of life and death. In the era of the soaring federal budget deficits of the Reagan administration. however. when and how to turn off an artificial life-support device. Medicare and Medicaid also brought to an end the era of segregation at U. together with the development of the civil rights movement after World War II. for institutions with segregated wards were ineligible to receive federal payments. Lee Iacocca. These exceptional scientific accomplishments. expenditures on health care in dollars increased nearly sixfold. private medical insurance companies like Blue Cross/Blue Shield began providing health care insurance to millions of middle-class citizens. Fewer and fewer doctors were engaged in solo practice. To most observers. and 1960s. not merely a privilege. the health care system was under increasing stress.S. Tens of millions of Americans still did not have access to health care. physicians increasingly began to practice in groups with other physicians. the enactment of the landmark Medicare (a federal program for individuals over 65) and Medicaid (joint federal and state programs for the poor) legislation extended health care coverage to millions of additional Americans.S. for they were competing with foreign companies that paid far less for employee health insurance than they did. how to preserve patient autonomy and to obtain proper informed consent for clinical care or research trials.

Any cost savings that were achieved were considered a secondary benefit.2 trillion 14 percent The Managed Care Era. medical schools. By the 1980s. the managed care movement has brought much good. the attempt to control costs had become the dominant force underlying the managed care movement. the twenty-first century has . it has encouraged greater attention to patients as consumers (for example. and the dollar-dominated medical marketplace has been highly injurious to medical education. and the requirement that patients be allowed to see specialists only if referred by a "gatekeeper.7 billion 4. the managed care movement has encouraged physicians to move many treatments and procedures from hospitals to less costly ambulatory settings. had been organized in the 1930s to achieve better coordination and continuity of care and to emphasize preventive medical services." Ironically. severe restrictions on the length of time a patient may remain in the hospital. Health Care Costs Dollars 1950 1965 1980 2000 Percentage of GDP $12. coupled with the inability of federal regulations and the medical profession on its own to achieve any meaningful cost control. In the view of many. in contrast to the "hands off" style of traditional feefor-service payment. In addition.U. there have been serious drawbacks to managed care that in the view of many observers have outweighed its accomplishments. when that can be done safely. led to the business-imposed approach of "managed care. the first health maintenance organization. and in the early years of President George Walker Bush's administration. Unquestionably. and teaching hospitals. mandated preauthorizations before hospitalization or surgery. better parking and more palatable hospital food). Managed care has not kept its promise of controlling health care costs. Managed care has also resulted in a serious loss of trust in doctors and the health care system—creating a widespread fear that doctors might be acting as "double agents.5 percent $40 billion (est.S.S. health care system. the emphasis on cost containment has come at the erosion of the quality of care." "Managed care" is a generic term that refers to a large variety of reimbursement plans in which third-party payers attempt to control costs by limiting the utilization of medical services. It has forced the medical profession for the first time to think seriously about costs.) 6 percent $230 billion 9 percent $1." allegedly serving patients but in fact refusing them needed tests and procedures in order to save money for the employing organization or insurance company. Examples of such cost-savings strategies include the requirement that physicians prescribe drugs only on a plan's approved formulary. the country once again faced double-digit health care inflation. As a result. however. Kaiser Permanente. 1985–present In the mid-1980s. and it has stimulated the use of modern information technologies and business practices in the U. However. soaring medical care costs.

many of the perceived abuses of managed care have less to do with the principles of managed care than with the presence of the profit motive in investor-owned managed care organizations." a profligate American practice style in which many doctors often perform unnecessary tests and procedures. while a low-cost system available to everyone is likely to be achieved at the price of diminishing quality. However. doctors. Lastly. there is much room to operate a more efficient. Bibliography . The practical problem in health care policy is that the pursuit of any two of these goals aggravates the third.S. a more accessible system of highquality care will tend to lead to higher costs. Only when all these issues are satisfactorily taken into account will the United States have a health care delivery system that matches the promise of what medical science and practice have to offer. Nonprofit managed care organizations. retaining the rest for the financial benefit of executives and investors. and recognizing that individuals must assume responsibility for their own health by choosing a healthy lifestyle. clinics. Medical insurance alone will not solve the health problems of a poor urban community where there are no hospitals. the for-profit problem is highly significant. or even 60 percent of the premiums on health services. Some astute observers of the U. However. This can be done by recognizing the broad determinants of health like good education and meaningful employment opportunities. retain about 5 percent of the health premiums they receive for administrative and capital expenses and use the remaining 95 percent to provide health care for enrollees. These include the high administrative costs of the U. health care system consider the for-profit motive in the delivery of medical services—rather than managed care per se—the more serious problem. health care system. At some point hard decisions will have to be made about what services will and will not be paid for. responsible health care delivery system in the United States at a more affordable price. a litigious culture that results in the high price of "defensive medicine. Yet the wiser and more efficient use of resources is only one challenge to our country's health care system. and affordable costs. the country will still face the problem of limited resources and seemingly limitless demand. Any efforts at cost containment must continue to be appropriately balanced with efforts to maintain high quality and patient advocacy in medical care.S. other causes of soaring health care costs are clearly less defensible. since 90 percent of managed care organizations are investor-owned companies. For-profit managed care companies. and the existence of for-profit managed care organizations and hospital chains that each year divert billions of dollars of health care premiums away from medical care and into private wealth. Future Challenges The U. seek to minimize what they call the "medical loss"—the portion of the health care premium that is actually used for health care." Ironically. the inflationary consequences of having a "third party" pay the bill (thereby removing incentives from both doctors and patients to conserve dollars).opened with a significant public backlash against managed care and a vociferous "patients' rights movement. Thus. health care system has three primary goals: the provision of high-quality care. they spend only 80. such as Kaiser Permanente. the American public must be wise and courageous enough to maintain realistic expectations of medicine. In the twenty-first century. Clearly. or pharmacies. in contrast. Instead of spending 95 percent of their premiums on health care (a "medical loss" of 95 percent).S. Certain causes of health care inflation are desirable and inevitable: an aging population and the development of new drugs and technologies. Better access to the system must also be provided. avoiding the "medicalization" of social ills like crime and drug addiction. 70. ready access to the system.

1982. In Sickness and in Wealth: America's Hospitals in the Twentieth Century. Princeton. Stevens.J. New Brunswick. Rodwin. Paul. Rosenberg. George. 1989. Victor R. and Morals: Physicians' Conflicts of Interest. Ludmerer. Health Policies. Rosemary. The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry. Daniel M. Edited by Charles E. The Profit Motive and Patient Care: The Changing Accountability of Doctors and Hospitals. Howard H.: Harvard University Press. 1999. . 1983. Mechanic. 1987.: Rutgers University Press. 2000. The Health Economy. Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. 1986.: Harvard University Press.Fox. Lundberg. Cambridge. Discussion of this nomination can be found on the talk page. New York: Basic Books. Mass. George D. Money. 1987. Philadelphia: University of Pennsylvania Press. 1991. Fuchs. New York: Basic Books. Mass. 1989. Kenneth M. Health Politics: The British and American Experience. Wikipedia: Health care Top Home > Library > Miscellaneous > Wikipedia This article has been nominated to be checked for its neutrality. see Health care (disambiguation). Hiatt. New York: Oxford University Press. New York: Oxford University Press. Charles E. Bradford H. Rosen. N. The Structure of American Medical Practice. (November 2009) For other uses. 1993.J. Starr. The Care of Strangers: The Rise of America's Hospital System. Medicine. New York: Basic Books. Severed Trust: Why American Medicine Hasn't Been Fixed. Gray. Rosenberg. 1875–1941. David. Painful Choices: Research and Essays on Health Care. 1911– 1965. N. Cambridge. Marc A. 1986. New York: Basic Books. America's Health in the Balance: Choice or Chance? New York: Harper and Row.: Princeton University Press.

English-speakers referred to medicine or to the health sector and spoke of the treatment and prevention of illness and disease. tough to define. and allied health professions. and the preservation of health through services offered by the medical. 2009</ref>. clinical sciences (in vitro diagnostics).[1] The definition of to recognize. curative and palliative interventions. including “preventive. complementary and alternative medicine. is the treatment and management of illnesses of the elderly. The International Red Cross and Red Crescent Movement is a well-known international relief movement. whether directed to individuals or to populations”. and the public health (the collective state and range of health in a population). The public health is related most to economic development and wealth distribution. nursing. health insurance (reimbursement of health care costs). or in access to of medical healthcare in individual health-seeking.1 World Health Organization 3 Economics 4 Systems 5 Politics 6 Health care by country .Surgery one of the most invasive. Before the term health care became popular. pharmaceutical. Contents [hide] • • • • • • 1 Health-care industry 2 Research ○ 2. difficult and expensive procedures in medicine. -promoting or -maintaining behaviours. Health care (often healthcare in British English)." Albany Times-Union November 12. and health insurance is a business which both provides and restricts reimbursement for healthcare itself in the event of disease. Health care embraces all the goods and services designed to promote health. dental. The social and political issue of access to healthcare in the US has led to public debate and confusing use of terms such as health care (medical management of illness or disease).

The last class consists of all activities for human health not performed by hospitals or by medical doctors or dentists. [4] According to government classifications of Industry. which focuses on iterative feedback loops between the basic and clinical research domains to accelerate knowledge translation from the bedside to the bench. chiropody. [5] Research See also: List of health care journals. and other human health activities. which are mostly based on the United Nations system.[6] . physiotherapists. or other para-medical practitioners in the field of optometry. The latter is termed preclinical research if its goal is specifically to elaborate knowledge for the development of new therapeutic strategies. acupuncture. nursing home. List of bioinformatics journals. music therapy. List of medical journals. or under the supervision of. medical massage. drug manufacturers. Europe spends a little less that the United States (€22.[2][3] The health-care industry incorporates several sectors that are dedicated to providing services and products dedicated to improving the health of individuals. Biomedical research (or experimental medicine).05bn in 2006) and there is less growth in European R&D spending. nursing homes. health care generally consists of Hospital activities. hospitals. pathology clinics. speech therapy. and back again.50bn compared to €27. is the basic research. drug delivery. or translational research conducted to aid the body of knowledge in the field of medicine. ambulance. etc. List of pharmaceutical sciences journals. medical equipment and instruments. homeopathy. occupational therapy. and all other research that contributes to the development of new treatments. A new paradigm to biomedical research is being termed translational research. applied research. hydrotherapy. the International Standard Industrial Classification. In terms of pharmaceutical R&D spending.• • • 7 See also 8 Notes 9 External links Health-care industry Main article: Health care industry The delivery of modern health care depends on an expanding group of trained professionals coming together as an interdisciplinary team. The particular sectors associated with these groups are: biotechnology. midwives. diagnostic laboratories. Medical and dental practice activities. British Medical Journal. According to market classifications of industry such as the Global Industry Classification Standard and the Industry Classification Benchmark the health-care industry includes health care equipment & services and pharmaceuticals. chiropractice. 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 the Journal of the American Medical Association are more general journals. diagnostic substances. nurses. in general simply known as medical research. The New England Journal of Medicine. scientific or diagnostic laboratiories. biotechnology & life sciences. and Medical literature Top impact factor academic journals in the health care field include Health Affairs and Milbank Quarterly. This involves activities of. providers of health care plans and home health care.

Voluntary contributions to the WHO from national and local governments. other UN organizations. [6][7] World Health Organization Main article: World Health Organization See also: Global health The World Health Organization (WHO) is a specialized United Nations agency which acts as a coordinator and researcher for public health around the world. the Health Organization. Broadly. these imbalances lead to market failures resulting from asymmetric information. Established on 7 April 1948. . now exceed that of assessed contributions (dues) from its 193 member nations. [7][8] However. In 1979 the WHO declared that the disease had been eradicated .[12] Governments tend to regulate the health care industry heavily and also tend to be the largest payer within the market. 2006. as well as with foundations such as the Bill and Melinda Gates Foundation and the Rockefeller Foundation. and the private sector (including pharmaceutical companies). currently around 80 such partnerships. especially key infectious diseases. The WHO is nearing success in developing vaccines against malaria and schistosomiasis and aims to eradicate polio within the next few years. accounting for the three quarters of the world’s biotechnology revenues and 80% of world R&D spending in biotechnology. with NGOs and the pharmaceutical industry. and to promote the general health of the peoples of the world.the first disease in history to be completely eliminated by deliberate human design. Examples of its work include years of fighting smallpox. asymmetric information.[11] Factors that distinguish health economics from other areas include extensive government intervention. A seminal 1963 article by Kenneth Arrow. foundations and NGOs. In recent years the WHO's work has involved more collaboration. health economists study the functioning of the health care system and the private and social causes of health-affecting behaviors such as smoking.[10] Economics Main article: Health economics Health economics is a branch of economics concerned with issues related to scarcity in the allocation of health and health care." Its major task is to combat disease. intractable uncertainty in several dimensions. Switzerland. The knowledge gap that exists between a physician and a patient can prevent the patient from accurately describing his symptoms or enable the physician to prescribe unnecessary but profitable services. the agency inherited the mandate and resources of its predecessor.[9] The WHO is financed by contributions from member states and from donors. The organization has already endorsed the world's first official HIV/AIDS Toolkit for Zimbabwe from October 3. The WHO's constitution states that its mission "is the attainment by all peoples of the highest possible level of health.[7] Pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States. Uncertainty is intrinsic to health. and externalities. the United States dominates the biopharmaceutical field. making it an international standard. and headquartered in Geneva. which had been an agency of the League of Nations. both in patient outcomes and financial concerns. Externalities arise frequently when considering health and health care. often credited with giving rise to the health economics as a discipline. drew conceptual distinctions between health and other goals.

making an effort to avoid catching a cold. Consuming just under 10 percent of gross domestic product of most developed nations. The scope of health economics is neatly encapsulated by Alan William's "plumbing diagram"[13] dividing the discipline into eight distinct topics: • • • • • • • • What influences health? (other than health care) What is health and what is its value The demand for health care The supply of health care Micro-economic evaluation at treatment level Market equilibrium Evaluation at whole system level. Main article: Health care system See also: Preventive medicine and Social medicine . In 2001. budgeting and monitoring mechanisms. Planning. and 13%.7%) being the top three. Japan. while Europe. and Germany (10.[7] United States accounts for the three quarters of the world’s biotechnology revenues. Systems A group of Chilean 'Damas de Rojo'.notably in the context of infectious disease. health care consumed 8. respectively. Switzerland (10. volunteers on their local hospital. The United States and Canada account for 48% of world pharmaceutical sales. or practising safer sex. 9%.9%). and all other nations account for 30%.4 per cent of GDP across the OECD countries[14] with the United States (13. health care can form an enormous part of a country's economy. affects people other than the decision maker.9%). and. For example.

Massachusetts and Connecticut. First is single payer. This is argued[by whom?] to provide a greater incentive to find cost-saving health care approaches. as found in most modernized countries as well as some states and municipalities within the United States. and this coverage and the services provided are regulated. affordable health care to state residents. state. an important political issue . 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. in which systems. and patients have more control of how they access care. A traditional view is that improvements in health result from advancements in medical science. consumers.S. In Brazil.[15] The United States currently operates under a mixed market health care system. they have less short and mediumterm incentives than private agents to make purchases that can generate revenues and avoid bankruptcy. there is consumer-driven health. with which the state of Massachusetts has experimented.[19] In Germany and France. and local) account for 45% of U. Finally. with recent examples being the Massachusetts 2006 Health Reform Statute[17] and Connecticut's SustiNet plan to provide quality. In almost every country. health care expenditures. 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. Second are employer or individual insurance mandates. for instance.[16] Private sources account for the remainder of costs. The medical model of health focuses on the eradication of illness through diagnosis and effective treatment. the greater problems with this approach have been the gradual deregulation of HMOs resulting in fewer of the promised choices for consumers. A few states have taken serious steps toward universal health care coverage. 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. system is allowed to operate. and the steady increase in consumer cost that has marginalized consumers and burdened states with excessive urgent health care costs that are avoided with consumers have adequate access to preventive health care. a term meant to describe a single agency managing a single system. The scale. 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. Government sources (federal. revolve around the use of private finance initiatives to build hospitals which it is argued costs taxpayers more in the long run. In contrast.Social health insurance is where a nation's entire population is eligible for health care coverage. and funding of these private systems is variable. most notably Minnesota. with proposals currently underway to integrate these systems in various ways to provide a number of health care options. This is sometimes referred to as two-tier health care. Health system reform in the United States usually focuses around three suggested systems. much as the current system operates. state or municipality with a government health care system a parallel private. extent. 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. and usually for-profit. concerns are more based on the rising cost of drugs to the governments. Critics of consumer-driven health say that it would benefit the healthy but be insufficient for the chronically sick.[18] Politics Main article: Health policy The politics of health care depends largely on which country one is in. Current concerns in England.

[23] In contrast.org alleges that Obama's predicted savings were exaggerated. whereas in others planning is made more centrally among governments. religious. supported a single-payer system. came under pressure for its refusal to admit there is any connection with AIDS[20] 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. an early candidate who did not get on the ballot.is the breach of intellectual property rights. for the domestic manufacture of antiretroviral drugs used in the treatment of HIV/AIDS. and costs associated with the US health care system. . charities. [22] (In contrast.) Factcheck. whose population sets the record for HIV infections. or patents. In some countries. The South African government. President Barack Obama says he favors the creation of a universal health care system. State boards and the Department of Health regulate inpatient care to reduce the national health care deficit. New York Times opinion columnist Paul Krugman said that Obama's plan would not actually provide universal coverage. However. [21] However. Health care by country Health care systems are designed to meet the health care needs of target populations. or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. trade unions. To tackle the problems of the perpetually increasing number of uninsured. the state of Oregon and the city of San Francisco are both examples of governments that adopted universal healthcare systems for strictly fiscal reasons. There are a wide variety of health care systems around the world. health care planning has often been evolutionary rather than revolutionary. Dennis Kucinich. the health care system planning is distributed among market participants.

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