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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
access public or charitable subsidization in order to remain economically viable. Lower population density also means a lower volume of patients and less provider income. while a nurse in a rural setting may visit only one or two patients. Primary care may be provided by nurse practitioners. immunizations) situated in central locations. Consequently. However. family planning. Prices. the cost per unit of service is often many times greater than in urban locations. and the poor with no access to hospital inpatient care. rural communities suffer chronic physician shortages. Home-based services in rural areas must. Small rural health care providers. and treatment. As costs increase. Physician shortages are most visible in primary prevention. Accessing complex care in urban medical centers often generates a patient perception that all rural hospital care is of lower quality. The lower the population density and the larger the area over which the population is distributed. Because of the distances between service locations or patient residences. advanced trauma care. Emergency medical services in such areas are scattered over great distances and often staffed . and the economic viability of the services. spending most of the time traveling. increasing costs. diagnosis. the area suffers from the significant loss of employment. Closures leave the very old. the ability of people to get to those services. Low population density and greater travel times and barriers in rural areas affect service availability. or home-health nurses. Neither of these populations generates reimbursements adequate to cover the costs of services. The urban nurse will be reimbursed for five visits and the rural nurse for two. a home health nurse may visit five patients in a morning within an urban apartment building. For example. prenatal care. rural residents must often travel great distances to access more costly and complex levels of care. Consequently. especially home-based or mobile services. public and private insurers must struggle to control their expenditures. and facilities. Reduced fees and the refusal of insurers to pay for care often destabilize private professional practices in rural areas. yet the time expended is the same. 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. Coronary bypass surgery. equipment. such as health departments.g. physician assistants. 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. the disabled. and market forces contribute to the economic destabilization of many rural health care systems.. Public health systems and an array of alternative primarycare providers often fill in the gaps. mobile clinics. churches. Many rural hospitals and providers have diversified services to increase revenues. and the entire community is left with no access to urgent or emergency care. the fewer the available health services and the longer the travel distances to access these services. Specialty physician services (such as psychiatry or dermatology) may also be available through intermittent clinics in local facilities. cannot afford the equipment and personnel necessary to treat the entire array of modern disease and injury. for services include the minimum estimated cost of providing each service. and other complex procedures require specialized medical teams. this strategy often fails and the hospital must close. Practice locations include publicly or charitably subsidized comprehensive primary-care centers or categorical service clinics (e.prepared to practice in rural environments. Such resources are economically viable only in hospitals and surgical centers with high volumes of patients. or schools. leading to greater shortages of personnel. especially hospitals. Advances in medical technology. therefore. or fee scales. In addition. Price controls most severely affect rural health systems. artery repair.
Germany. Traditional Medical Practice in America For the first century of the republic. like medical knowledge and medical practice. Prenatal Care. health care systems reflect the changing scientific and technologic nature of medical practice. physicians in the United States. private insurance. and in rural. or suburban locations). regardless of sex and age. More remote areas with the capacity to pay for the technology. or in massive corporate organizations. Canada. and Great Britain follow similar medical practices.with volunteers who have other jobs. Public Health Nursing) — SUSAN W. 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. but the health care systems of these nations vary considerably. The delivery of care refers to how and where medical services are provided (for example. or various types of outpatient clinics. France. Poverty and Health. in hospitals. and alternative practitioners) and whether they are practicing as individuals." whereby they practiced by themselves without . Of particular interest to a health care system is how medical care is organized. and delivered. urban. almost all physicians engaged in "general practice"—the provision of medical and surgical care for all diseases and for all patients. specialist physicians. doctors' offices. In part. 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. in small groups. such as western Kansas. The organization of care refers to such issues as who gives care (for example. HEATHER REED US History Encyclopedia: Health Care Top Home > Library > History. such as mountains or rivers. magnify the effects of distance. Medicare. ISAAC. reflecting the different cultural values and mores of those societies. causing increased morbidity and mortality. doctors engaged in "solo practice. in large groups. financed. Primary Care. Thus. A country's health care system also reflects in part the culture and values of that society. such as stroke and heart attack. primary care physicians. may take longer to arrive than in other areas. Migrant Workers. Health care systems. 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. such as psychiatry and dermatology. are not fixed but are continually evolving. self-pay. However. Poor roads or geographic barriers. For instance. Emergency care for severe trauma or major acute illnesses. The financing of care involves who pays for medical services (for example. or Medicaid) and how much money is spent on medical care. are beginning to use telemedicine to improve access for primary care and certain specialty care. nurses. (SEE ALSO: Immunizations. Typically. Prevention.
fueled by the growing results of scientific research and the resultant transformation of medical practice—antibiotics. House calls were common. hospital wards were segregated by race. and large wards for indigent patients where as many as thirty or forty "charity" patients would be housed together in one wide open room. fueled by the revolution in medical science (particularly the rise of bacteriology and modern surgery). there were 661 hospitals in the United States containing in aggregate about 30. vitamins. Many physicians could not be kept busy practicing medicine. and by 1940 formal certifying boards in the major clinical specialties had been established. and patients would pay out of pocket. particularly in the South. In the 1920s.S. a "two-tiered" system of health care officially existed—private rooms in hospitals for paying patients. Table 1 Specialization in Medicine American Board of Ophthalmology American Board of Pediatrics 191 6 193 3 . As one manifestation of this phenomenon. Competition for patients from alternative healers diminished. specialty medicine was already becoming prominent. Doctors' offices were typically at their homes or farms. and many effective new drugs and operations—the cultural authority of doctors continued to grow. childbirth. Reflecting the rural makeup of the country. Before World War II (1939–1945). Physician income. the U. Residency programs in the clinical specialties had been created. on average. and it was common for doctors to have a second business like a farm. fee-for-service practice. was not high. where larger concentrations of patients could be found. and doctors often received payment in kind—a chicken or box of fruit rather than money. doctors were increasingly found in larger metropolises. about 75 to 80 percent of doctors continued to engage in general practice. physician earned 2½ times the income of the average worker.partners.000. Doctors also experienced vigorous competition for patients from a variety of alternative or lay healers like Thomsonians. and together they contained about one million beds. and major medical problems. general store. and most Americans thought of consulting a doctor if they needed medical services.) Most physicians continued in solo. most physicians resided in rural settings.000 beds. Indeed. hormones. Medicine at this time was not an easy way for an individual to earn a living. or pharmacy. However.S. safer childbirth. and the average U. the technologic capacity and cultural authority of physicians in the United States began to escalate. population was still 50 percent rural. The location of care moved to doctors' offices for routine illnesses and to hospitals for surgery. By 1940. Since most hospitals were concentrated in cities and large towns. but already 80 percent of physicians resided in cities or large towns. antiseizure medications. homeopaths. and health care was not yet considered a fundamental right. Decade by decade. In many hospitals and clinics. competition to "regular medicine" from alternative healers had markedly slackened. (Some medical specialists earned much more. By 1930." In 1875. Doctors would give patients a bill. the hospital came to be considered the "doctor's workshop. the number of acute care hospitals had increased to around 7. In the last quarter of the nineteenth century and first quarter of the twentieth century. Payment was on the "fee-for-service" basis. and faith healers.
By midcentury. corticosteroids. Powerful diagnostic tools were developed. In 1900. such as automated chemistry analyzers.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. and a variety of organ transplantations. computerized tomography. antihypertensive drugs. and heart attacks had replaced infections as the major causes of death. radioimmunoassays. chronic diseases such as cancer. such as newer and more powerful antibiotics. stroke. average life expectancy in the United States was forty-seven years. hip replacements. Equally impressive therapeutic procedures came into use. immunosuppressants. mechanical ventilators. most notably the polio vaccine. and the major causes of death each year were various infections. New vaccines. openheart surgery. kidney dialysis machines. Most Americans now faced the . and nuclear magnetic resonance imaging. 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. and by the end of the century life expectancy in the United States had increased about 30 years from that of 1900. were developed.
Despite these accomplishments. that number had climbed to around 48 million. and health care costs rose from 6 percent to 9 percent of the country's gross domestic product (GDP)." which was estimated to be two to four times as much as in other Western industrialized nations. for they were competing with foreign companies that paid far less for employee health insurance than they did. When he left office in 2001. physicians increasingly began to practice in groups with other physicians. others argued that there was an overemphasis on disease treatment and a relative neglect of disease prevention and health promotion. expenditures on health care in dollars increased nearly sixfold. health care system became inundated with paperwork and "red tape. stunned many Americans by pointing out that U. These exceptional scientific accomplishments. And the scientific and technological advances of medicine created a host of unprecedented ethical issues: the meaning of life and death. while president of Chrysler in the late 1970s. for institutions with segregated wards were ineligible to receive federal payments. this meant unprecedented financial prosperity and minimal interference by payers in medical decision-making.) Many patients and health policy experts complained of the fragmentation of services that resulted from increasing specialization. however. (When President Bill Clinton assumed office in 1993. when and how to turn off an artificial life-support device. Millions of Americans became unwillingly tied to their employers. The increasingly complicated U. In the 1940s. the health care system was under increasing stress. 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. and 1960s.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. hospitals. In the era of the soaring federal budget deficits of the Reagan administration. Table 2 . by 1960. automobile companies were spending more per car on health premiums for workers than for the steel that went into the automobiles.S. most American physicians were still general practitioners. resulted in profound changes in the country's health care delivery system. Medicare and Medicaid also brought to an end the era of segregation at U. For providers of medical care. how to preserve patient autonomy and to obtain proper informed consent for clinical care or research trials. together with the development of the civil rights movement after World War II. Tens of millions of Americans still did not have access to health care. 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. 85 to 90 percent of medical graduates were choosing careers in specialty or subspecialty medicine.S. In 1965. Public opinion polls of the early 1980s revealed that 60 percent of the population worried about health care costs. 1950s. the number of uninsured Americans was estimated at 40 million. To most observers.S. Fewer and fewer doctors were engaged in solo practice. Employers found their competitiveness in the global market to be compromised. Third-party payers of this era continued to reimburse physicians and hospitals on a fee-for-service basis. Before the war. these problems seemed even more insurmountable. Lee Iacocca. the most critical problem of the health care system was soaring costs. This change in attitude was financed by the rise of "third-party payers" that brought more and more Americans into the health care system. compared with only 10 percent who worried about the quality of care. however. not merely a privilege. In the fifteen years following the passage of Medicare and Medicaid. private medical insurance companies like Blue Cross/Blue Shield began providing health care insurance to millions of middle-class citizens. unable to switch to a better job because of the loss of health care benefits if they did so.
U.7 billion 4." Ironically. the managed care movement has brought much good. coupled with the inability of federal regulations and the medical profession on its own to achieve any meaningful cost control. As a result.2 trillion 14 percent The Managed Care Era. and the dollar-dominated medical marketplace has been highly injurious to medical education. Any cost savings that were achieved were considered a secondary benefit. the country once again faced double-digit health care inflation. 1985–present In the mid-1980s. Kaiser Permanente.S. By the 1980s. and in the early years of President George Walker Bush's administration. health care system. there have been serious drawbacks to managed care that in the view of many observers have outweighed its accomplishments. better parking and more palatable hospital food). and teaching hospitals. medical schools. it has encouraged greater attention to patients as consumers (for example. had been organized in the 1930s to achieve better coordination and continuity of care and to emphasize preventive medical services. the twenty-first century has . the managed care movement has encouraged physicians to move many treatments and procedures from hospitals to less costly ambulatory settings.5 percent $40 billion (est. however. In the view of many. soaring medical care costs.) 6 percent $230 billion 9 percent $1. severe restrictions on the length of time a patient may remain in the hospital. In addition. However. mandated preauthorizations before hospitalization or surgery." allegedly serving patients but in fact refusing them needed tests and procedures in order to save money for the employing organization or insurance company. Managed care has not kept its promise of controlling health care costs. and the requirement that patients be allowed to see specialists only if referred by a "gatekeeper. Health Care Costs Dollars 1950 1965 1980 2000 Percentage of GDP $12. when that can be done safely. 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. the first health maintenance organization. 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. in contrast to the "hands off" style of traditional feefor-service payment. and it has stimulated the use of modern information technologies and business practices in the U. Examples of such cost-savings strategies include the requirement that physicians prescribe drugs only on a plan's approved formulary.S. the attempt to control costs had become the dominant force underlying the managed care movement. led to the business-imposed approach of "managed care. Unquestionably.
Yet the wiser and more efficient use of resources is only one challenge to our country's health care system. a more accessible system of highquality care will tend to lead to higher costs. Clearly.S. the country will still face the problem of limited resources and seemingly limitless demand. ready access to the system. and recognizing that individuals must assume responsibility for their own health by choosing a healthy lifestyle. health care system has three primary goals: the provision of high-quality care.opened with a significant public backlash against managed care and a vociferous "patients' rights movement. since 90 percent of managed care organizations are investor-owned companies. Instead of spending 95 percent of their premiums on health care (a "medical loss" of 95 percent). in contrast. However. However. or even 60 percent of the premiums on health services. The practical problem in health care policy is that the pursuit of any two of these goals aggravates the third. there is much room to operate a more efficient. while a low-cost system available to everyone is likely to be achieved at the price of diminishing quality.S. or pharmacies. 70. doctors. Some astute observers of the U. Better access to the system must also be provided. Thus. For-profit managed care companies. Future Challenges The U.S." Ironically. avoiding the "medicalization" of social ills like crime and drug addiction. Nonprofit managed care organizations. health care system. they spend only 80. Medical insurance alone will not solve the health problems of a poor urban community where there are no hospitals. At some point hard decisions will have to be made about what services will and will not be paid for. seek to minimize what they call the "medical loss"—the portion of the health care premium that is actually used for health care. clinics. 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. the American public must be wise and courageous enough to maintain realistic expectations of medicine. 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. In the twenty-first century. responsible health care delivery system in the United States at a more affordable price. such as Kaiser Permanente. and affordable costs. Lastly. Certain causes of health care inflation are desirable and inevitable: an aging population and the development of new drugs and technologies. 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. Bibliography . Any efforts at cost containment must continue to be appropriately balanced with efforts to maintain high quality and patient advocacy in medical care. the inflationary consequences of having a "third party" pay the bill (thereby removing incentives from both doctors and patients to conserve dollars). a litigious culture that results in the high price of "defensive medicine. 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. retaining the rest for the financial benefit of executives and investors. the for-profit problem is highly significant." a profligate American practice style in which many doctors often perform unnecessary tests and procedures. other causes of soaring health care costs are clearly less defensible. This can be done by recognizing the broad determinants of health like good education and meaningful employment opportunities. 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.
Charles E. The Structure of American Medical Practice. America's Health in the Balance: Choice or Chance? New York: Harper and Row.: Princeton University Press. 1983. New York: Basic Books.Fox. N. 1989. George D. Severed Trust: Why American Medicine Hasn't Been Fixed. Gray. Marc A. 1911– 1965. and Morals: Physicians' Conflicts of Interest. Health Policies. Edited by Charles E. Painful Choices: Research and Essays on Health Care. New York: Basic Books. Wikipedia: Health care Top Home > Library > Miscellaneous > Wikipedia This article has been nominated to be checked for its neutrality. Rosenberg. 1987. The Care of Strangers: The Rise of America's Hospital System. Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. Hiatt. Health Politics: The British and American Experience. In Sickness and in Wealth: America's Hospitals in the Twentieth Century. 1993. New York: Basic Books. 1986. Lundberg. Cambridge. 2000. Daniel M. The Profit Motive and Patient Care: The Changing Accountability of Doctors and Hospitals. Paul. N. Mass. Rosemary. New York: Oxford University Press. 1982. Mechanic. New York: Oxford University Press. Cambridge. Starr. Discussion of this nomination can be found on the talk page.: Rutgers University Press. (November 2009) For other uses. . Victor R. Rosen. Bradford H. Rodwin. 1986.: Harvard University Press. Howard H. New Brunswick. 1989. 1999. see Health care (disambiguation). The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry. Princeton. New York: Basic Books. 1991. Kenneth M.: Harvard University Press. George. Ludmerer. Fuchs. 1987. 1875–1941. Money. Rosenberg. Stevens. Medicine. Mass. David.J.J. The Health Economy. Philadelphia: University of Pennsylvania Press.
including “preventive. Health care (often healthcare in British English). nursing. dental. curative and palliative interventions. tough to define. and the preservation of health through services offered by the medical. 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). English-speakers referred to medicine or to the health sector and spoke of the treatment and prevention of illness and disease. Health care embraces all the goods and services designed to promote health. clinical sciences (in vitro diagnostics). or in access to of medical healthcare in individual health-seeking. difficult and expensive procedures in medicine. complementary and alternative medicine. health insurance (reimbursement of health care costs). The International Red Cross and Red Crescent Movement is a well-known international relief movement. Contents [hide] • • • • • • 1 Health-care industry 2 Research ○ 2. The public health is related most to economic development and wealth distribution. whether directed to individuals or to populations”. The definition of to recognize. and the public health (the collective state and range of health in a population). and allied health professions.Surgery one of the most invasive. 2009</ref>. is the treatment and management of illnesses of the elderly. -promoting or -maintaining behaviours. and health insurance is a business which both provides and restricts reimbursement for healthcare itself in the event of disease. pharmaceutical." Albany Times-Union November 12.1 World Health Organization 3 Economics 4 Systems 5 Politics 6 Health care by country . Before the term health care became popular.
The latter is termed preclinical research if its goal is specifically to elaborate knowledge for the development of new therapeutic strategies. acupuncture. British Medical Journal. in general simply known as medical research. ambulance. The New England Journal of Medicine. scientific or diagnostic laboratiories. medical massage. which are mostly based on the United Nations system. nursing home. and all other research that contributes to the development of new treatments. Biomedical research (or experimental medicine). drug manufacturers. A new paradigm to biomedical research is being termed translational research. The last class consists of all activities for human health not performed by hospitals or by medical doctors or dentists. diagnostic substances. applied research. providers of health care plans and home health care. Europe spends a little less that the United States (€22. music therapy. and other human health activities. health care generally consists of Hospital activities. homeopathy. diagnostic laboratories. This involves activities of. midwives. medical equipment and instruments. is the basic research. etc. or under the supervision of. The health-care industry incorporates several sectors that are dedicated to providing services and products dedicated to improving the health of individuals. drug delivery. The particular sectors associated with these groups are: biotechnology. and Medical literature Top impact factor academic journals in the health care field include Health Affairs and Milbank Quarterly. 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.• • • 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. and back again. List of pharmaceutical sciences journals. biotechnology & life sciences. nurses. Medical and dental practice activities. In terms of pharmaceutical R&D spending. List of bioinformatics journals. physiotherapists.  Research See also: List of health care journals. or other para-medical practitioners in the field of optometry.05bn in 2006) and there is less growth in European R&D spending. pathology clinics. hospitals. which focuses on iterative feedback loops between the basic and clinical research domains to accelerate knowledge translation from the bedside to the bench. and the Journal of the American Medical Association are more general journals. nursing homes. . the International Standard Industrial Classification. List of medical journals. 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.50bn compared to €27. occupational therapy. hydrotherapy.  According to government classifications of Industry. chiropractice. chiropody. speech therapy. or translational research conducted to aid the body of knowledge in the field of medicine.
intractable uncertainty in several dimensions. health economists study the functioning of the health care system and the private and social causes of health-affecting behaviors such as smoking. drew conceptual distinctions between health and other goals. The WHO's constitution states that its mission "is the attainment by all peoples of the highest possible level of health. Externalities arise frequently when considering health and health care. foundations and NGOs. In recent years the WHO's work has involved more collaboration. now exceed that of assessed contributions (dues) from its 193 member nations. often credited with giving rise to the health economics as a discipline. and externalities. The organization has already endorsed the world's first official HIV/AIDS Toolkit for Zimbabwe from October 3. Uncertainty is intrinsic to health. In 1979 the WHO declared that the disease had been eradicated . 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. with NGOs and the pharmaceutical industry. 2006. Factors that distinguish health economics from other areas include extensive government intervention. currently around 80 such partnerships. the United States dominates the biopharmaceutical field. Voluntary contributions to the WHO from national and local governments. Switzerland. the Health Organization. the agency inherited the mandate and resources of its predecessor. and to promote the general health of the peoples of the world. Governments tend to regulate the health care industry heavily and also tend to be the largest payer within the market. A seminal 1963 article by Kenneth Arrow. these imbalances lead to market failures resulting from asymmetric information. Examples of its work include years of fighting smallpox. both in patient outcomes and financial concerns. The WHO is financed by contributions from member states and from donors." Its major task is to combat disease. Pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States. Established on 7 April 1948.  However. which had been an agency of the League of Nations. and the private sector (including pharmaceutical companies). making it an international standard. . 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. accounting for the three quarters of the world’s biotechnology revenues and 80% of world R&D spending in biotechnology.the first disease in history to be completely eliminated by deliberate human design. Broadly. especially key infectious diseases. other UN organizations. and headquartered in Geneva. as well as with foundations such as the Bill and Melinda Gates Foundation and the Rockefeller Foundation.  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 WHO is nearing success in developing vaccines against malaria and schistosomiasis and aims to eradicate polio within the next few years. asymmetric information.
9%). Consuming just under 10 percent of gross domestic product of most developed nations. and Germany (10. and. United States accounts for the three quarters of the world’s biotechnology revenues. affects people other than the decision maker. 9%.7%) being the top three. making an effort to avoid catching a cold. Main article: Health care system See also: Preventive medicine and Social medicine . Japan. health care consumed 8.9%). health care can form an enormous part of a country's economy. Planning. while Europe. and all other nations account for 30%.notably in the context of infectious disease. respectively. The scope of health economics is neatly encapsulated by Alan William's "plumbing diagram" 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.4 per cent of GDP across the OECD countries with the United States (13. budgeting and monitoring mechanisms. Switzerland (10. or practising safer sex. For example. and 13%. volunteers on their local hospital. In 2001. The United States and Canada account for 48% of world pharmaceutical sales. Systems A group of Chilean 'Damas de Rojo'.
in which systems. state. The scale. 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 Germany and France. and local) account for 45% of U. Politics Main article: Health policy The politics of health care depends largely on which country one is in. a term meant to describe a single agency managing a single system. Critics of consumer-driven health say that it would benefit the healthy but be insufficient for the chronically sick. This is sometimes referred to as two-tier health care. with which the state of Massachusetts has experimented. A few states have taken serious steps toward universal health care coverage. 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. extent. The medical model of health focuses on the eradication of illness through diagnosis and effective treatment. consumers. an important political issue . Health system reform in the United States usually focuses around three suggested systems. In contrast. affordable health care to state residents. 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. Second are employer or individual insurance mandates. 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. Over the past thirty years. First is single payer. A traditional view is that improvements in health result from advancements in medical science. for instance. much as the current system operates. Massachusetts and Connecticut. state or municipality with a government health care system a parallel private. there is consumer-driven health. with recent examples being the Massachusetts 2006 Health Reform Statute and Connecticut's SustiNet plan to provide quality. In Brazil. and funding of these private systems is variable. This is argued[by whom?] to provide a greater incentive to find cost-saving health care approaches. Finally. Government sources (federal. concerns are more based on the rising cost of drugs to the governments. with proposals currently underway to integrate these systems in various ways to provide a number of health care options. 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. In almost every country. and usually for-profit. most notably Minnesota. system is allowed to operate. as found in most modernized countries as well as some states and municipalities within the United States. revolve around the use of private finance initiatives to build hospitals which it is argued costs taxpayers more in the long run. Private sources account for the remainder of costs.Social health insurance is where a nation's entire population is eligible for health care coverage. health care expenditures. the greater problems with this approach have been the gradual deregulation of HMOs resulting in fewer of the promised choices for consumers.S. and this coverage and the services provided are regulated. Current concerns in England. 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. 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 patients have more control of how they access care.
or patents. an early candidate who did not get on the ballot. Health care by country Health care systems are designed to meet the health care needs of target populations. New York Times opinion columnist Paul Krugman said that Obama's plan would not actually provide universal coverage. and costs associated with the US health care system.  (In contrast.is the breach of intellectual property rights. for the domestic manufacture of antiretroviral drugs used in the treatment of HIV/AIDS.  However. Dennis Kucinich. trade unions. supported a single-payer system.) Factcheck. the state of Oregon and the city of San Francisco are both examples of governments that adopted universal healthcare systems for strictly fiscal reasons. However. In the United States 12% to 16% of the citizens are still unable to afford health insurance. religious. whose population sets the record for HIV infections. There are a wide variety of health care systems around the world. State boards and the Department of Health regulate inpatient care to reduce the national health care deficit.  In contrast. The South African government. health care planning has often been evolutionary rather than revolutionary. whereas in others planning is made more centrally among governments. charities. President Barack Obama says he favors the creation of a universal health care system. or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. .org alleges that Obama's predicted savings were exaggerated. To tackle the problems of the perpetually increasing number of uninsured. came under pressure for its refusal to admit there is any connection with AIDS because of the cost it would have involved. the health care system planning is distributed among market participants. In some countries.
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