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
Consequently. mobile clinics. and the entire community is left with no access to urgent or emergency care. Low population density and greater travel times and barriers in rural areas affect service availability. physician assistants. In addition.. such as health departments. and in patient's homes. Accessing complex care in urban medical centers often generates a patient perception that all rural hospital care is of lower quality. and facilities. leading to greater shortages of personnel. Advances in medical technology. the cost per unit of service is often many times greater than in urban locations. Prices. or schools. family planning. and other complex procedures require specialized medical teams. Neither of these populations generates reimbursements adequate to cover the costs of services. immunizations) situated in central locations. As costs increase. 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. or home-health nurses. and treatment. especially home-based or mobile services. Because of the distances between service locations or patient residences. Many rural hospitals and providers have diversified services to increase revenues. access public or charitable subsidization in order to remain economically viable. rural communities suffer chronic physician shortages. Public health systems and an array of alternative primarycare providers often fill in the gaps. equipment. For example. this strategy often fails and the hospital must close. Emergency medical services in such areas are scattered over great distances and often staffed
. and market forces contribute to the economic destabilization of many rural health care systems. and the poor with no access to hospital inpatient care. yet the time expended is the same. the area suffers from the significant loss of employment. Primary care may be provided by nurse practitioners. Such resources are economically viable only in hospitals and surgical centers with high volumes of patients. Coronary bypass surgery. the fewer the available health services and the longer the travel distances to access these services. prenatal care. the disabled. 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. Consequently. Closures leave the very old. Lower population density also means a lower volume of patients and less provider income. rural residents must often travel great distances to access more costly and complex levels of care. advanced trauma care. the ability of people to get to those services. People with financial resources and the ability to travel tend to use distant urban centers even for less complex needs. a home health nurse may visit five patients in a morning within an urban apartment building. and the economic viability of the services. artery repair.prepared to practice in rural environments. therefore. The urban nurse will be reimbursed for five visits and the rural nurse for two. However. Price controls most severely affect rural health systems. while a nurse in a rural setting may visit only one or two patients. for services include the minimum estimated cost of providing each service. Practice locations include publicly or charitably subsidized comprehensive primary-care centers or categorical service clinics (e. spending most of the time traveling. Reduced fees and the refusal of insurers to pay for care often destabilize private professional practices in rural areas. or fee scales. Small rural health care providers. Physician shortages are most visible in primary prevention. increasing costs. churches. The lower the population density and the larger the area over which the population is distributed. Home-based services in rural areas must.g. especially hospitals. diagnosis. public and private insurers must struggle to control their expenditures.
or in massive corporate organizations. Public Health Nursing) — SUSAN W. Poverty and Health. Poor roads or geographic barriers. private insurance. in large groups. primary care physicians. physicians in the United States. are beginning to use telemedicine to improve access for primary care and certain specialty care. or suburban locations). doctors engaged in "solo practice. health care systems reflect the changing scientific and technologic nature of medical practice. doctors' offices. but the health care systems of these nations vary considerably. HEATHER REED
US History Encyclopedia: Health Care Top Home > Library > History. in hospitals. financed. urban. such as psychiatry and dermatology. The financing of care involves who pays for medical services (for example.with volunteers who have other jobs. are not fixed but are continually evolving. and in rural. self-pay. France. A country's health care system also reflects in part the culture and values of that society. (SEE ALSO: Immunizations. such as mountains or rivers. Emergency care for severe trauma or major acute illnesses. Prevention. Medicare. For instance." whereby they practiced by themselves without
. or various types of outpatient clinics. Typically. The delivery of care refers to how and where medical services are provided (for example. nurses. Prenatal Care. and Great Britain follow similar medical practices. However. specialist physicians. like medical knowledge and medical practice. Health care systems. causing increased morbidity and mortality. such as stroke and heart attack. ISAAC. Traditional Medical Practice in America For the first century of the republic. reflecting the different cultural values and mores of those societies. almost all physicians engaged in "general practice"—the provision of medical and surgical care for all diseases and for all patients. in small groups. Migrant Workers. and alternative practitioners) and whether they are practicing as individuals. 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. 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. More remote areas with the capacity to pay for the technology. magnify the effects of distance. Canada. In part. Germany. 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. and delivered. or Medicaid) and how much money is spent on medical care. Primary Care. Thus. regardless of sex and age. Of particular interest to a health care system is how medical care is organized. such as western Kansas. The organization of care refers to such issues as who gives care (for example. may take longer to arrive than in other areas.
the technologic capacity and cultural authority of physicians in the United States began to escalate. the hospital came to be considered the "doctor's workshop. and together they contained about one million beds. the number of acute care hospitals had increased to around 7. Since most hospitals were concentrated in cities and large towns. fueled by the growing results of scientific research and the resultant transformation of medical practice—antibiotics. Doctors' offices were typically at their homes or farms. By 1930. hormones. antiseizure medications. Doctors also experienced vigorous competition for patients from a variety of alternative or lay healers like Thomsonians. safer childbirth.000. doctors were increasingly found in larger metropolises. and many effective new drugs and operations—the cultural authority of doctors continued to grow. Table 1
Specialization in Medicine American Board of Ophthalmology American Board of Pediatrics 191 6 193 3
. Physician income. and the average U. The location of care moved to doctors' offices for routine illnesses and to hospitals for surgery. particularly in the South. on average. and doctors often received payment in kind—a chicken or box of fruit rather than money. Payment was on the "fee-for-service" basis.S. In the last quarter of the nineteenth century and first quarter of the twentieth century. most physicians resided in rural settings. a "two-tiered" system of health care officially existed—private rooms in hospitals for paying patients. In many hospitals and clinics. By 1940.) Most physicians continued in solo. Indeed. about 75 to 80 percent of doctors continued to engage in general practice. (Some medical specialists earned much more. fee-for-service practice. homeopaths.S. but already 80 percent of physicians resided in cities or large towns.partners. However. fueled by the revolution in medical science (particularly the rise of bacteriology and modern surgery). the U. and most Americans thought of consulting a doctor if they needed medical services. Medicine at this time was not an easy way for an individual to earn a living. population was still 50 percent rural. Residency programs in the clinical specialties had been created.000 beds. In the 1920s. Many physicians could not be kept busy practicing medicine. Before World War II (1939–1945). and patients would pay out of pocket. hospital wards were segregated by race. House calls were common." In 1875. competition to "regular medicine" from alternative healers had markedly slackened. there were 661 hospitals in the United States containing in aggregate about 30. and major medical problems. and it was common for doctors to have a second business like a farm. where larger concentrations of patients could be found. Doctors would give patients a bill. As one manifestation of this phenomenon. Reflecting the rural makeup of the country. childbirth. physician earned 2½ times the income of the average worker. general store. or pharmacy. specialty medicine was already becoming prominent. and by 1940 formal certifying boards in the major clinical specialties had been established. and large wards for indigent patients where as many as thirty or forty "charity" patients would be housed together in one wide open room. and faith healers. and health care was not yet considered a fundamental right. Competition for patients from alternative healers diminished. was not high. vitamins. Decade by decade.
were developed. radioimmunoassays. mechanical ventilators. openheart surgery. and heart attacks had replaced infections as the major causes of death. chronic diseases such as cancer. stroke. In 1900. Most Americans now faced the
. such as automated chemistry analyzers. kidney dialysis machines. corticosteroids. Equally impressive therapeutic procedures came into use. immunosuppressants. 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. Powerful diagnostic tools were developed. such as newer and more powerful antibiotics. and the major causes of death each year were various infections. most notably the polio vaccine.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 nuclear magnetic resonance imaging. By midcentury. hip replacements. New vaccines. computerized tomography. and by the end of the century life expectancy in the United States had increased about 30 years from that of 1900. average life expectancy in the United States was forty-seven years. antihypertensive drugs. and a variety of organ transplantations.
In the 1940s. Employers found their competitiveness in the global market to be compromised. private medical insurance companies like Blue Cross/Blue Shield began providing health care insurance to millions of middle-class citizens.S. In the fifteen years following the passage of Medicare and Medicaid. hospitals. unable to switch to a better job because of the loss of health care benefits if they did so. Fewer and fewer doctors were engaged in solo practice. for they were competing with foreign companies that paid far less for employee health insurance than they did. Despite these accomplishments. however. For providers of medical care. In 1965.S. however. for institutions with segregated wards were ineligible to receive federal payments." which was estimated to be two to four times as much as in other Western industrialized nations. 1950s. most American physicians were still general practitioners. 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 the era of the soaring federal budget deficits of the Reagan administration. while president of Chrysler in the late 1970s. Lee Iacocca. To most observers. Medicare and Medicaid also brought to an end the era of segregation at U. And the scientific and technological advances of medicine created a host of unprecedented ethical issues: the meaning of life and death. health care system became inundated with paperwork and "red tape. Millions of Americans became unwillingly tied to their employers. these problems seemed even more insurmountable. These exceptional scientific accomplishments. Third-party payers of this era continued to reimburse physicians and hospitals on a fee-for-service basis. resulted in profound changes in the country's health care delivery system. compared with only 10 percent who worried about the quality of care. When he left office in 2001. this meant unprecedented financial prosperity and minimal interference by payers in medical decision-making. automobile companies were spending more per car on health premiums for workers than for the steel that went into the automobiles. and 1960s. others argued that there was an overemphasis on disease treatment and a relative neglect of disease prevention and health promotion. together with the development of the civil rights movement after World War II. Before the war. 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. the number of uninsured Americans was estimated at 40 million.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. The increasingly complicated U. expenditures on health care in dollars increased nearly sixfold. by 1960. (When President Bill Clinton assumed office in 1993. instead. The egalitarian spirit of post–World War II society resulted in the new view that health care was a fundamental right of all citizens. 85 to 90 percent of medical graduates were choosing careers in specialty or subspecialty medicine. and health care costs rose from 6 percent to 9 percent of the country's gross domestic product (GDP). Public opinion polls of the early 1980s revealed that 60 percent of the population worried about health care costs. Tens of millions of Americans still did not have access to health care. Table 2
. the most critical problem of the health care system was soaring costs. the health care system was under increasing stress. when and how to turn off an artificial life-support device. how to preserve patient autonomy and to obtain proper informed consent for clinical care or research trials. not merely a privilege. physicians increasingly began to practice in groups with other physicians. stunned many Americans by pointing out that U.S. that number had climbed to around 48 million.) Many patients and health policy experts complained of the fragmentation of services that resulted from increasing specialization.
the attempt to control costs had become the dominant force underlying the managed care movement. led to the business-imposed approach of "managed care. and the requirement that patients be allowed to see specialists only if referred by a "gatekeeper.5 percent $40 billion (est. and in the early years of President George Walker Bush's administration. the twenty-first century has
. and the dollar-dominated medical marketplace has been highly injurious to medical education. coupled with the inability of federal regulations and the medical profession on its own to achieve any meaningful cost control.S.U. severe restrictions on the length of time a patient may remain in the hospital. when that can be done safely.) 6 percent
$230 billion 9 percent $1. Kaiser Permanente. Any cost savings that were achieved were considered a secondary benefit. It has forced the medical profession for the first time to think seriously about costs. the emphasis on cost containment has come at the erosion of the quality of care.S. however. there have been serious drawbacks to managed care that in the view of many observers have outweighed its accomplishments." allegedly serving patients but in fact refusing them needed tests and procedures in order to save money for the employing organization or insurance company. mandated preauthorizations before hospitalization or surgery. Managed care has not kept its promise of controlling health care costs." "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. As a result. the managed care movement has encouraged physicians to move many treatments and procedures from hospitals to less costly ambulatory settings. In the view of many. soaring medical care costs. medical schools. health care system. Unquestionably. 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 country once again faced double-digit health care inflation. it has encouraged greater attention to patients as consumers (for example. in contrast to the "hands off" style of traditional feefor-service payment. By the 1980s. and it has stimulated the use of modern information technologies and business practices in the U.7 billion 4.2 trillion 14 percent
The Managed Care Era. Examples of such cost-savings strategies include the requirement that physicians prescribe drugs only on a plan's approved formulary. better parking and more palatable hospital food). Health Care Costs Dollars 1950 1965 1980 2000 Percentage of GDP
$12. In addition. the managed care movement has brought much good." Ironically. and teaching hospitals. However. had been organized in the 1930s to achieve better coordination and continuity of care and to emphasize preventive medical services. 1985–present
In the mid-1980s.
This can be done by recognizing the broad determinants of health like good education and meaningful employment opportunities. Better access to the system must also be provided. These include the high administrative costs of 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. 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. 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. the inflationary consequences of having a "third party" pay the bill (thereby removing incentives from both doctors and patients to conserve dollars). the American public must be wise and courageous enough to maintain realistic expectations of medicine. For-profit managed care companies.S. health care system consider the for-profit motive in the delivery of medical services—rather than managed care per se—the more serious problem. 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. responsible health care delivery system in the United States at a more affordable price. 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. 70. Certain causes of health care inflation are desirable and inevitable: an aging population and the development of new drugs and technologies. the for-profit problem is highly significant. they spend only 80. since 90 percent of managed care organizations are investor-owned companies. while a low-cost system available to everyone is likely to be achieved at the price of diminishing quality. such as Kaiser Permanente." Ironically. Future Challenges The U. Any efforts at cost containment must continue to be appropriately balanced with efforts to maintain high quality and patient advocacy in medical care. Medical insurance alone will not solve the health problems of a poor urban community where there are no hospitals. Bibliography
.S. or even 60 percent of the premiums on health services. a litigious culture that results in the high price of "defensive medicine. Clearly.S. and affordable costs. and recognizing that individuals must assume responsibility for their own health by choosing a healthy lifestyle. Some astute observers of the U." a profligate American practice style in which many doctors often perform unnecessary tests and procedures. clinics. Thus. ready access to the system. Nonprofit managed care organizations. the country will still face the problem of limited resources and seemingly limitless demand. doctors. other causes of soaring health care costs are clearly less defensible. However. retaining the rest for the financial benefit of executives and investors. a more accessible system of highquality care will tend to lead to higher costs. health care system. Lastly. avoiding the "medicalization" of social ills like crime and drug addiction. in contrast. there is much room to operate a more efficient. The practical problem in health care policy is that the pursuit of any two of these goals aggravates the third.opened with a significant public backlash against managed care and a vociferous "patients' rights movement. However. Yet the wiser and more efficient use of resources is only one challenge to our country's health care system. Instead of spending 95 percent of their premiums on health care (a "medical loss" of 95 percent). health care system has three primary goals: the provision of high-quality care. In the twenty-first century. At some point hard decisions will have to be made about what services will and will not be paid for. or pharmacies.
Mechanic. 2000. Victor R. Paul.: Harvard University Press. Severed Trust: Why American Medicine Hasn't Been Fixed. Hiatt. The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry. 1999.J. 1911– 1965. The Health Economy. 1982. Starr.
. Marc A. 1875–1941. New York: Basic Books. 1986. Bradford H.Fox. David. Rodwin. New York: Oxford University Press. Edited by Charles E. George. see Health care (disambiguation). Cambridge. and Morals: Physicians' Conflicts of Interest.: Rutgers University Press. The Profit Motive and Patient Care: The Changing Accountability of Doctors and Hospitals. Rosenberg. New Brunswick. Medicine. New York: Oxford University Press. Cambridge. Stevens.
Wikipedia: Health care Top Home > Library > Miscellaneous > Wikipedia This article has been nominated to be checked for its neutrality. (November 2009) For other uses. 1993. America's Health in the Balance: Choice or Chance? New York: Harper and Row. New York: Basic Books. The Structure of American Medical Practice. Money. Health Policies. Howard H. 1987. Ludmerer. Painful Choices: Research and Essays on Health Care. N. Philadelphia: University of Pennsylvania Press.: Harvard University Press. 1989. 1991. Rosemary. Gray. Daniel M. Health Politics: The British and American Experience. New York: Basic Books. In Sickness and in Wealth: America's Hospitals in the Twentieth Century. George D. Mass. Mass. Kenneth M.J. Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. The Care of Strangers: The Rise of America's Hospital System. 1986. N. Lundberg. Fuchs.: Princeton University Press. Rosenberg. 1989. 1983. New York: Basic Books. Princeton. Discussion of this nomination can be found on the talk page. Charles E. 1987. Rosen.
[hide] • • • • • • 1 Health-care industry 2 Research ○ 2. including “preventive.
The International Red Cross and Red Crescent Movement is a well-known international relief movement. The public health is related most to economic development and wealth distribution. complementary and alternative medicine.
Health care (often healthcare in British English). Before the term health care became popular. and allied health professions. The definition of to recognize. curative and palliative interventions. and the public health (the collective state and range of health in a population). -promoting or -maintaining behaviours. 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). or in access to of medical healthcare in individual health-seeking. health insurance (reimbursement of health care costs). dental.Surgery one of the most invasive. pharmaceutical. clinical sciences (in vitro diagnostics). Health care embraces all the goods and services designed to promote health. is the treatment and management of illnesses of the elderly. tough to define. whether directed to individuals or to populations”. and health insurance is a business which both provides and restricts reimbursement for healthcare itself in the event of disease." Albany Times-Union November 12. English-speakers referred to medicine or to the health sector and spoke of the treatment and prevention of illness and disease.1 World Health Organization 3 Economics 4 Systems 5 Politics 6 Health care by country
. and the preservation of health through services offered by the medical. difficult and expensive procedures in medicine.
which focuses on iterative feedback loops between the basic and clinical research domains to accelerate knowledge translation from the bedside to the bench. is the basic research. In terms of pharmaceutical R&D spending. Europe spends a little less that the United States (€22. Biomedical research (or experimental medicine). hospitals. drug delivery. Medical and dental practice activities. scientific or diagnostic laboratiories. nursing homes.• • •
7 See also 8 Notes 9 External links
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. health care generally consists of Hospital activities. applied research. acupuncture. music therapy. biotechnology & life sciences. diagnostic laboratories. which are mostly based on the United Nations system. and all other research that contributes to the development of new treatments. providers of health care plans and home health care. The health-care industry incorporates several sectors that are dedicated to providing services and products dedicated to improving the health of individuals.
. drug manufacturers. The New England Journal of Medicine. ambulance. or translational research conducted to aid the body of knowledge in the field of medicine. or other para-medical practitioners in the field of optometry. This involves activities of. British Medical Journal. 
See also: List of health care journals. hydrotherapy. chiropody. or under the supervision of. The particular sectors associated with these groups are: biotechnology.  According to government classifications of Industry. List of medical journals. and the Journal of the American Medical Association are more general journals. nursing home. List of pharmaceutical sciences journals. and back again. A new paradigm to biomedical research is being termed translational research. chiropractice. List of bioinformatics journals. and other human health activities. occupational therapy. in general simply known as medical research. the International Standard Industrial Classification. 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. medical massage. diagnostic substances. homeopathy. The last class consists of all activities for human health not performed by hospitals or by medical doctors or dentists. speech therapy. pathology clinics. midwives.05bn in 2006) and there is less growth in European R&D spending. physiotherapists. The latter is termed preclinical research if its goal is specifically to elaborate knowledge for the development of new therapeutic strategies. medical equipment and instruments.50bn compared to €27. and Medical literature
Top impact factor academic journals in the health care field include Health Affairs and Milbank Quarterly. nurses. etc. 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.
intractable uncertainty in several dimensions. The organization has already endorsed the world's first official HIV/AIDS Toolkit for Zimbabwe from October 3. currently around 80 such partnerships. Factors that distinguish health economics from other areas include extensive government intervention. and externalities. as well as with foundations such as the Bill and Melinda Gates Foundation and the Rockefeller Foundation. the Health Organization. which had been an agency of the League of Nations.the first disease in history to be completely eliminated by deliberate human design. Broadly. In recent years the WHO's work has involved more collaboration.
. Externalities arise frequently when considering health and health care. Switzerland.
Pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States. The WHO's constitution states that its mission "is the attainment by all peoples of the highest possible level of health. The WHO is nearing success in developing vaccines against malaria and schistosomiasis and aims to eradicate polio within the next few years. often credited with giving rise to the health economics as a discipline. especially key infectious diseases. the agency inherited the mandate and resources of its predecessor. now exceed that of assessed contributions (dues) from its 193 member nations. making it an international standard. and to promote the general health of the peoples of the world. foundations and NGOs. the United States dominates the biopharmaceutical field. Established on 7 April 1948.
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. other UN organizations. 2006. asymmetric information. accounting for the three quarters of the world’s biotechnology revenues and 80% of world R&D spending in biotechnology. and headquartered in Geneva. 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. A seminal 1963 article by Kenneth Arrow. these imbalances lead to market failures resulting from asymmetric information. with NGOs and the pharmaceutical industry. Uncertainty is intrinsic to health. Governments tend to regulate the health care industry heavily and also tend to be the largest payer within the market. drew conceptual distinctions between health and other goals. 
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. health economists study the functioning of the health care system and the private and social causes of health-affecting behaviors such as smoking." Its major task is to combat disease. In 1979 the WHO declared that the disease had been eradicated . Voluntary contributions to the WHO from national and local governments. both in patient outcomes and financial concerns. The WHO is financed by contributions from member states and from donors. and the private sector (including pharmaceutical companies).  However. Examples of its work include years of fighting smallpox.
Switzerland (10. making an effort to avoid catching a cold. affects people other than the decision maker.9%). Japan. and 13%. budgeting and monitoring mechanisms. while Europe. or practising safer sex. Main article: Health care system See also: Preventive medicine and Social medicine
. and. For example.9%). Planning. health care can form an enormous part of a country's economy.4 per cent of GDP across the OECD countries with the United States (13. 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. 9%. In 2001. United States accounts for the three quarters of the world’s biotechnology revenues.notably in the context of infectious disease. volunteers on their local hospital. and all other nations account for 30%.
A group of Chilean 'Damas de Rojo'.7%) being the top three. respectively.
Consuming just under 10 percent of gross domestic product of most developed nations. The United States and Canada account for 48% of world pharmaceutical sales. and Germany (10. health care consumed 8.
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 almost every country. Private sources account for the remainder of costs. in which systems. Health system reform in the United States usually focuses around three suggested systems. much as the current system operates. This is sometimes referred to as two-tier health care. an important political issue
. health care expenditures. A traditional view is that improvements in health result from advancements in medical science. extent.S. First is single payer. consumers. and local) account for 45% of U. as found in most modernized countries as well as some states and municipalities within the United States. In contrast. state. with which the state of Massachusetts has experimented. 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. with proposals currently underway to integrate these systems in various ways to provide a number of health care options. 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. 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.
Main article: Health policy
The politics of health care depends largely on which country one is in. Current concerns in England. with recent examples being the Massachusetts 2006 Health Reform Statute and Connecticut's SustiNet plan to provide quality. and funding of these private systems is variable. Over the past thirty years. Massachusetts and Connecticut. Finally. they have less short and mediumterm incentives than private agents to make purchases that can generate revenues and avoid bankruptcy. for instance. The scale. This is argued[by whom?] to provide a greater incentive to find cost-saving health care approaches. In Germany and France. 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. A few states have taken serious steps toward universal health care coverage. Critics of consumer-driven health say that it would benefit the healthy but be insufficient for the chronically sick. there is consumer-driven health. state or municipality with a government health care system a parallel private. affordable health care to state residents. Government sources (federal. The United States currently operates under a mixed market health care system. The medical model of health focuses on the eradication of illness through diagnosis and effective treatment. Second are employer or individual insurance mandates. and usually for-profit. most notably Minnesota. and this coverage and the services provided are regulated. system is allowed to operate. the greater problems with this approach have been the gradual deregulation of HMOs resulting in fewer of the promised choices for consumers. concerns are more based on the rising cost of drugs to the governments. 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. In Brazil. revolve around the use of private finance initiatives to build hospitals which it is argued costs taxpayers more in the long run. a term meant to describe a single agency managing a single system.Social health insurance is where a nation's entire population is eligible for health care coverage.
However. The South African government. or patents. whereas in others planning is made more centrally among governments. religious.  In contrast. There are a wide variety of health care systems around the world. the state of Oregon and the city of San Francisco are both examples of governments that adopted universal healthcare systems for strictly fiscal reasons. for the domestic manufacture of antiretroviral drugs used in the treatment of HIV/AIDS. State boards and the Department of Health regulate inpatient care to reduce the national health care deficit.is the breach of intellectual property rights. Dennis Kucinich.
.org alleges that Obama's predicted savings were exaggerated. charities.
Health care by country
Health care systems are designed to meet the health care needs of target populations. To tackle the problems of the perpetually increasing number of uninsured. whose population sets the record for HIV infections. trade unions. supported a single-payer system.  (In contrast.  However. health care planning has often been evolutionary rather than revolutionary. President Barack Obama says he favors the creation of a universal health care system. In some countries. New York Times opinion columnist Paul Krugman said that Obama's plan would not actually provide universal coverage. an early candidate who did not get on the ballot. the health care system planning is distributed among market participants. came under pressure for its refusal to admit there is any connection with AIDS because of the cost it would have involved.) Factcheck. In the United States 12% to 16% of the citizens are still unable to afford health insurance. or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. and costs associated with the US health care system.