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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
Such resources are economically viable only in hospitals and surgical centers with high volumes of patients.prepared to practice in rural environments. diagnosis. or home-health nurses. Advances in medical technology. the area suffers from the significant loss of employment. the ability of people to get to those services. Public health systems and an array of alternative primarycare providers often fill in the gaps. prenatal care. while a nurse in a rural setting may visit only one or two patients. especially hospitals. 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. public and private insurers must struggle to control their expenditures. increasing costs. access public or charitable subsidization in order to remain economically viable. Home-based services in rural areas must. this strategy often fails and the hospital must close. and the economic viability of the services. Primary care may be provided by nurse practitioners. Many rural hospitals and providers have diversified services to increase revenues. physician assistants. or schools. family planning. or fee scales. and the poor with no access to hospital inpatient care. For example. rural communities suffer chronic physician shortages. immunizations) situated in central locations. cannot afford the equipment and personnel necessary to treat the entire array of modern disease and injury. Because of the distances between service locations or patient residences. therefore. Emergency medical services in such areas are scattered over great distances and often staffed . rural residents must often travel great distances to access more costly and complex levels of care. However. especially home-based or mobile services.g.. equipment. Prices. Closures leave the very old. the disabled. the cost per unit of service is often many times greater than in urban locations. and the entire community is left with no access to urgent or emergency care. and facilities. and market forces contribute to the economic destabilization of many rural health care systems. churches. a home health nurse may visit five patients in a morning within an urban apartment building. Physician shortages are most visible in primary prevention. Neither of these populations generates reimbursements adequate to cover the costs of services. As costs increase. such as health departments. In addition. and in patient's homes. Lower population density also means a lower volume of patients and less provider income. Specialty physician services (such as psychiatry or dermatology) may also be available through intermittent clinics in local facilities. Accessing complex care in urban medical centers often generates a patient perception that all rural hospital care is of lower quality. spending most of the time traveling. Consequently. advanced trauma care. Consequently. Reduced fees and the refusal of insurers to pay for care often destabilize private professional practices in rural areas. and treatment. for services include the minimum estimated cost of providing each service. the fewer the available health services and the longer the travel distances to access these services. Small rural health care providers. The urban nurse will be reimbursed for five visits and the rural nurse for two. leading to greater shortages of personnel. People with financial resources and the ability to travel tend to use distant urban centers even for less complex needs. yet the time expended is the same. Practice locations include publicly or charitably subsidized comprehensive primary-care centers or categorical service clinics (e. and other complex procedures require specialized medical teams. Coronary bypass surgery. Price controls most severely affect rural health systems. Low population density and greater travel times and barriers in rural areas affect service availability. artery repair. mobile clinics. The lower the population density and the larger the area over which the population is distributed.
with volunteers who have other jobs. like medical knowledge and medical practice. (SEE ALSO: Immunizations. Primary Care. physicians in the United States. such as stroke and heart attack. ISAAC. Canada." whereby they practiced by themselves without . or in massive corporate organizations. For instance. Traditional Medical Practice in America For the first century of the republic. health care systems reflect the changing scientific and technologic nature of medical practice. The delivery of care refers to how and where medical services are provided (for example. such as western Kansas. Poor roads or geographic barriers. Migrant Workers. The financing of care involves who pays for medical services (for example. regardless of sex and age. and in rural. self-pay. Poverty and Health. almost all physicians engaged in "general practice"—the provision of medical and surgical care for all diseases and for all patients. However. doctors' offices. and delivered. or various types of outpatient clinics. Prenatal Care. are beginning to use telemedicine to improve access for primary care and certain specialty care. and Great Britain follow similar medical practices. and alternative practitioners) and whether they are practicing as individuals. A country's health care system also reflects in part the culture and values of that society. in hospitals. urban. More remote areas with the capacity to pay for the technology. Thus. causing increased morbidity and mortality. Typically. 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. Germany. Prevention. reflecting the different cultural values and mores of those societies. private insurance. or Medicaid) and how much money is spent on medical care. France. such as mountains or rivers. may take longer to arrive than in other areas. primary care physicians. Of particular interest to a health care system is how medical care is organized. nurses. in small groups. In part. such as psychiatry and dermatology. or suburban locations). Public Health Nursing) — SUSAN W. specialist physicians. Emergency care for severe trauma or major acute illnesses. Medicare. 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. Health care systems. but the health care systems of these nations vary considerably. magnify the effects of distance. are not fixed but are continually evolving. financed. HEATHER REED US History Encyclopedia: Health Care Top Home > Library > History. 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. The organization of care refers to such issues as who gives care (for example. in large groups. doctors engaged in "solo practice.
the technologic capacity and cultural authority of physicians in the United States began to escalate. doctors were increasingly found in larger metropolises. and many effective new drugs and operations—the cultural authority of doctors continued to grow. and faith healers. the hospital came to be considered the "doctor's workshop. but already 80 percent of physicians resided in cities or large towns. By 1940.000." In 1875. on average. hospital wards were segregated by race. safer childbirth. However. As one manifestation of this phenomenon. specialty medicine was already becoming prominent. Payment was on the "fee-for-service" basis. (Some medical specialists earned much more. Doctors' offices were typically at their homes or farms. where larger concentrations of patients could be found. there were 661 hospitals in the United States containing in aggregate about 30. was not high. fueled by the growing results of scientific research and the resultant transformation of medical practice—antibiotics.S. Doctors would give patients a bill. particularly in the South. Many physicians could not be kept busy practicing medicine. population was still 50 percent rural. about 75 to 80 percent of doctors continued to engage in general practice. antiseizure medications. The location of care moved to doctors' offices for routine illnesses and to hospitals for surgery. the U. and major medical problems. vitamins.partners. and large wards for indigent patients where as many as thirty or forty "charity" patients would be housed together in one wide open room.000 beds. Table 1 Specialization in Medicine American Board of Ophthalmology American Board of Pediatrics 191 6 193 3 . Before World War II (1939–1945). or pharmacy. and the average U. childbirth. and health care was not yet considered a fundamental right. and it was common for doctors to have a second business like a farm. hormones. Reflecting the rural makeup of the country. a "two-tiered" system of health care officially existed—private rooms in hospitals for paying patients. In the last quarter of the nineteenth century and first quarter of the twentieth century.S. and most Americans thought of consulting a doctor if they needed medical services. Decade by decade. fueled by the revolution in medical science (particularly the rise of bacteriology and modern surgery). most physicians resided in rural settings. Residency programs in the clinical specialties had been created. By 1930. and together they contained about one million beds. Indeed. the number of acute care hospitals had increased to around 7. homeopaths. In the 1920s. fee-for-service practice. In many hospitals and clinics. and doctors often received payment in kind—a chicken or box of fruit rather than money.) Most physicians continued in solo. physician earned 2½ times the income of the average worker. Medicine at this time was not an easy way for an individual to earn a living. Since most hospitals were concentrated in cities and large towns. general store. Physician income. and patients would pay out of pocket. competition to "regular medicine" from alternative healers had markedly slackened. and by 1940 formal certifying boards in the major clinical specialties had been established. Doctors also experienced vigorous competition for patients from a variety of alternative or lay healers like Thomsonians. Competition for patients from alternative healers diminished. House calls were common.
immunosuppressants. and heart attacks had replaced infections as the major causes of death. mechanical ventilators. stroke. hip replacements.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. average life expectancy in the United States was forty-seven years. In 1900. radioimmunoassays. were developed. antihypertensive drugs. corticosteroids. and by the end of the century life expectancy in the United States had increased about 30 years from that of 1900. New vaccines. and the major causes of death each year were various infections. Equally impressive therapeutic procedures came into use. and nuclear magnetic resonance imaging. Most Americans now faced the . openheart surgery. such as newer and more powerful antibiotics. most notably the polio vaccine. By midcentury. and a variety of organ transplantations. Powerful diagnostic tools were developed. kidney dialysis machines. 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. chronic diseases such as cancer. computerized tomography. such as automated chemistry analyzers.
S. automobile companies were spending more per car on health premiums for workers than for the steel that went into the automobiles. health care system became inundated with paperwork and "red tape. Public opinion polls of the early 1980s revealed that 60 percent of the population worried about health care costs. The egalitarian spirit of post–World War II society resulted in the new view that health care was a fundamental right of all citizens. Despite these accomplishments. instead. 1950s. The increasingly complicated U. the number of uninsured Americans was estimated at 40 million. Fewer and fewer doctors were engaged in solo practice. and 1960s. 85 to 90 percent of medical graduates were choosing careers in specialty or subspecialty medicine. Medicare and Medicaid also brought to an end the era of segregation at U. the health care system was under increasing stress. Before the war. compared with only 10 percent who worried about the quality of care. When he left office in 2001. Lee Iacocca. not merely a privilege. that number had climbed to around 48 million. private medical insurance companies like Blue Cross/Blue Shield began providing health care insurance to millions of middle-class citizens. these problems seemed even more insurmountable. how to preserve patient autonomy and to obtain proper informed consent for clinical care or research trials. This change in attitude was financed by the rise of "third-party payers" that brought more and more Americans into the health care system. Table 2 . In the 1940s. Employers found their competitiveness in the global market to be compromised. the most critical problem of the health care system was soaring costs. Millions of Americans became unwillingly tied to their employers. stunned many Americans by pointing out that U. In the fifteen years following the passage of Medicare and Medicaid. however.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. These exceptional scientific accomplishments. In the era of the soaring federal budget deficits of the Reagan administration. resulted in profound changes in the country's health care delivery system. Third-party payers of this era continued to reimburse physicians and hospitals on a fee-for-service basis. In 1965. together with the development of the civil rights movement after World War II." which was estimated to be two to four times as much as in other Western industrialized nations. 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 the scientific and technological advances of medicine created a host of unprecedented ethical issues: the meaning of life and death.S.S. for institutions with segregated wards were ineligible to receive federal payments. by 1960. most American physicians were still general practitioners. and health care costs rose from 6 percent to 9 percent of the country's gross domestic product (GDP). physicians increasingly began to practice in groups with other physicians. Tens of millions of Americans still did not have access to health care.) Many patients and health policy experts complained of the fragmentation of services that resulted from increasing specialization. For providers of medical care. when and how to turn off an artificial life-support device. however. expenditures on health care in dollars increased nearly sixfold. (When President Bill Clinton assumed office in 1993. hospitals. for they were competing with foreign companies that paid far less for employee health insurance than they did. others argued that there was an overemphasis on disease treatment and a relative neglect of disease prevention and health promotion. while president of Chrysler in the late 1970s. this meant unprecedented financial prosperity and minimal interference by payers in medical decision-making. To most observers. unable to switch to a better job because of the loss of health care benefits if they did so.
health care system. By the 1980s." allegedly serving patients but in fact refusing them needed tests and procedures in order to save money for the employing organization or insurance company. Kaiser Permanente.S. when that can be done safely.7 billion 4. the twenty-first century has . severe restrictions on the length of time a patient may remain in the hospital. and the requirement that patients be allowed to see specialists only if referred by a "gatekeeper. It has forced the medical profession for the first time to think seriously about 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. Unquestionably.5 percent $40 billion (est. led to the business-imposed approach of "managed care. coupled with the inability of federal regulations and the medical profession on its own to achieve any meaningful cost control. and the dollar-dominated medical marketplace has been highly injurious to medical education. the first health maintenance organization. However. the emphasis on cost containment has come at the erosion of the quality of care. As a result.S. Managed care has not kept its promise of controlling health care costs. the country once again faced double-digit health care inflation.2 trillion 14 percent The Managed Care Era. the managed care movement has brought much good. and in the early years of President George Walker Bush's administration. soaring medical care costs. and it has stimulated the use of modern information technologies and business practices in the U. mandated preauthorizations before hospitalization or surgery." Ironically. Examples of such cost-savings strategies include the requirement that physicians prescribe drugs only on a plan's approved formulary. the managed care movement has encouraged physicians to move many treatments and procedures from hospitals to less costly ambulatory settings. it has encouraged greater attention to patients as consumers (for example. however.) 6 percent $230 billion 9 percent $1. better parking and more palatable hospital food). Health Care Costs Dollars 1950 1965 1980 2000 Percentage of GDP $12. in contrast to the "hands off" style of traditional feefor-service payment. In addition." "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. Any cost savings that were achieved were considered a secondary benefit. and teaching hospitals. In the view of many. had been organized in the 1930s to achieve better coordination and continuity of care and to emphasize preventive medical services.U. the attempt to control costs had become the dominant force underlying the managed care movement. 1985–present In the mid-1980s. there have been serious drawbacks to managed care that in the view of many observers have outweighed its accomplishments. medical schools.
However. the American public must be wise and courageous enough to maintain realistic expectations of medicine." Ironically. and recognizing that individuals must assume responsibility for their own health by choosing a healthy lifestyle. retaining the rest for the financial benefit of executives and investors.S. For-profit managed care companies. This can be done by recognizing the broad determinants of health like good education and meaningful employment opportunities. ready access to the system. Any efforts at cost containment must continue to be appropriately balanced with efforts to maintain high quality and patient advocacy in medical care." a profligate American practice style in which many doctors often perform unnecessary tests and procedures. In the twenty-first century. Instead of spending 95 percent of their premiums on health care (a "medical loss" of 95 percent). or pharmacies. other causes of soaring health care costs are clearly less defensible. and affordable costs.opened with a significant public backlash against managed care and a vociferous "patients' rights movement. Nonprofit managed care organizations. 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. 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. Bibliography . The practical problem in health care policy is that the pursuit of any two of these goals aggravates the third. the inflationary consequences of having a "third party" pay the bill (thereby removing incentives from both doctors and patients to conserve dollars). there is much room to operate a more efficient. These include the high administrative costs of the U. they spend only 80. since 90 percent of managed care organizations are investor-owned companies. a litigious culture that results in the high price of "defensive medicine. health care system has three primary goals: the provision of high-quality care. doctors. Thus. a more accessible system of highquality care will tend to lead to higher costs.S. or even 60 percent of the premiums on health services. avoiding the "medicalization" of social ills like crime and drug addiction. 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 contrast. At some point hard decisions will have to be made about what services will and will not be paid for. such as Kaiser Permanente. Clearly. the country will still face the problem of limited resources and seemingly limitless demand. Lastly. Better access to the system must also be provided. 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. responsible health care delivery system in the United States at a more affordable price. Some astute observers of the U. Medical insurance alone will not solve the health problems of a poor urban community where there are no hospitals. Yet the wiser and more efficient use of resources is only one challenge to our country's health care system.S. health care system. the for-profit problem is highly significant. seek to minimize what they call the "medical loss"—the portion of the health care premium that is actually used for health care. However. while a low-cost system available to everyone is likely to be achieved at the price of diminishing quality. 70. Future Challenges 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. clinics. Certain causes of health care inflation are desirable and inevitable: an aging population and the development of new drugs and technologies.
Kenneth M. New York: Basic Books. Stevens. The Care of Strangers: The Rise of America's Hospital System.Fox. 1982. 1875–1941. (November 2009) For other uses. Victor R.: Harvard University Press.: Princeton University Press. Rosemary. N. New York: Oxford University Press. 1987. Hiatt. Medicine. Rosen. Marc A. 1991. Philadelphia: University of Pennsylvania Press. N. Painful Choices: Research and Essays on Health Care. Fuchs. 1989. Health Policies. 1987. Severed Trust: Why American Medicine Hasn't Been Fixed. 1911– 1965. 1989. Charles E. Cambridge. George D. Wikipedia: Health care Top Home > Library > Miscellaneous > Wikipedia This article has been nominated to be checked for its neutrality. see Health care (disambiguation). George. Rodwin. New York: Basic Books. Money. Ludmerer. 1999. 1986. Cambridge.: Harvard University Press. Starr. Edited by Charles E. New York: Basic Books. The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry. Gray. New York: Oxford University Press. . Howard H. Mass. Rosenberg. Bradford H. Mass. America's Health in the Balance: Choice or Chance? New York: Harper and Row. New York: Basic Books. The Structure of American Medical Practice. Lundberg. Paul.J. David. Rosenberg. 1986. New Brunswick. Mechanic. The Profit Motive and Patient Care: The Changing Accountability of Doctors and Hospitals. Princeton. The Health Economy. 2000. Health Politics: The British and American Experience. Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. Discussion of this nomination can be found on the talk page.: Rutgers University Press. 1983. In Sickness and in Wealth: America's Hospitals in the Twentieth Century. Daniel M. 1993.J. and Morals: Physicians' Conflicts of Interest.
including “preventive. Contents [hide] • • • • • • 1 Health-care industry 2 Research ○ 2. 2009</ref>. nursing. or in access to of medical healthcare in individual health-seeking. Before the term health care became popular. The public health is related most to economic development and wealth distribution.1 World Health Organization 3 Economics 4 Systems 5 Politics 6 Health care by country . tough to define. complementary and alternative medicine. and the public health (the collective state and range of health in a population). and the preservation of health through services offered by the medical. Health care embraces all the goods and services designed to promote health. The definition of to recognize. 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). whether directed to individuals or to populations”. Health care (often healthcare in British English). dental. The International Red Cross and Red Crescent Movement is a well-known international relief movement. English-speakers referred to medicine or to the health sector and spoke of the treatment and prevention of illness and disease. health insurance (reimbursement of health care costs). -promoting or -maintaining behaviours. curative and palliative interventions. is the treatment and management of illnesses of the elderly. pharmaceutical. clinical sciences (in vitro diagnostics). and allied health professions. difficult and expensive procedures in medicine. and health insurance is a business which both provides and restricts reimbursement for healthcare itself in the event of disease.Surgery one of the most invasive." Albany Times-Union November 12.
50bn compared to €27. music therapy. Biomedical research (or experimental medicine). Medical and dental practice activities. in general simply known as medical research. A new paradigm to biomedical research is being termed translational research. speech therapy. the International Standard Industrial Classification. nurses. applied research. pathology clinics. nursing homes. or under the supervision of. etc. The health-care industry incorporates several sectors that are dedicated to providing services and products dedicated to improving the health of individuals. hospitals. physiotherapists. . 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.05bn in 2006) and there is less growth in European 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. or translational research conducted to aid the body of knowledge in the field of medicine. medical equipment and instruments. 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. biotechnology & life sciences. occupational therapy. and back again. and the Journal of the American Medical Association are more general journals. midwives. nursing home. and all other research that contributes to the development of new treatments. which focuses on iterative feedback loops between the basic and clinical research domains to accelerate knowledge translation from the bedside to the bench. The latter is termed preclinical research if its goal is specifically to elaborate knowledge for the development of new therapeutic strategies. In terms of pharmaceutical R&D spending. List of bioinformatics journals. diagnostic substances. is the basic research. homeopathy. and other human health activities. which are mostly based on the United Nations system. The New England Journal of Medicine. British Medical Journal. diagnostic laboratories. The last class consists of all activities for human health not performed by hospitals or by medical doctors or dentists. medical massage. acupuncture.  According to government classifications of Industry. List of medical journals. Europe spends a little less that the United States (€22. drug delivery. This involves activities of. chiropractice. List of pharmaceutical sciences journals. drug manufacturers. chiropody. scientific or diagnostic laboratiories. providers of health care plans and home health care. health care generally consists of Hospital activities. hydrotherapy.  Research See also: List of health care journals. ambulance. The particular sectors associated with these groups are: biotechnology. or other para-medical practitioners in the field of optometry. and Medical literature Top impact factor academic journals in the health care field include Health Affairs and Milbank Quarterly.
" Its major task is to combat disease. and the private sector (including pharmaceutical companies). 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. A seminal 1963 article by Kenneth Arrow. Switzerland. Voluntary contributions to the WHO from national and local governments. the United States dominates the biopharmaceutical field. both in patient outcomes and financial concerns. The WHO's constitution states that its mission "is the attainment by all peoples of the highest possible level of health. drew conceptual distinctions between health and other goals. the agency inherited the mandate and resources of its predecessor.  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. intractable uncertainty in several dimensions. Pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States. with NGOs and the pharmaceutical industry. especially key infectious diseases. Broadly.the first disease in history to be completely eliminated by deliberate human design. The WHO is nearing success in developing vaccines against malaria and schistosomiasis and aims to eradicate polio within the next few years. Governments tend to regulate the health care industry heavily and also tend to be the largest payer within the market. often credited with giving rise to the health economics as a discipline. health economists study the functioning of the health care system and the private and social causes of health-affecting behaviors such as smoking. and to promote the general health of the peoples of the world. Externalities arise frequently when considering health and health care.  However. the Health Organization. making it an international standard. and headquartered in Geneva. 2006. asymmetric information. In recent years the WHO's work has involved more collaboration. which had been an agency of the League of Nations. In 1979 the WHO declared that the disease had been eradicated . and externalities. currently around 80 such partnerships. . Examples of its work include years of fighting smallpox. Uncertainty is intrinsic to health. accounting for the three quarters of the world’s biotechnology revenues and 80% of world R&D spending in biotechnology. these imbalances lead to market failures resulting from asymmetric information. other UN organizations. foundations and NGOs. now exceed that of assessed contributions (dues) from its 193 member nations. The WHO is financed by contributions from member states and from donors. 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 organization has already endorsed the world's first official HIV/AIDS Toolkit for Zimbabwe from October 3. Factors that distinguish health economics from other areas include extensive government intervention. Established on 7 April 1948. as well as with foundations such as the Bill and Melinda Gates Foundation and the Rockefeller Foundation.
Planning. and all other nations account for 30%. United States accounts for the three quarters of the world’s biotechnology revenues. 9%.9%). budgeting and monitoring mechanisms. and Germany (10.9%). and. making an effort to avoid catching a cold. and 13%. while Europe. affects people other than the decision maker. The United States and Canada account for 48% of world pharmaceutical sales. Consuming just under 10 percent of gross domestic product of most developed nations. health care can form an enormous part of a country's economy.7%) being the top three. For example. 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. volunteers on their local hospital. Main article: Health care system See also: Preventive medicine and Social medicine . respectively. or practising safer sex. Japan. Systems A group of Chilean 'Damas de Rojo'. health care consumed 8.4 per cent of GDP across the OECD countries with the United States (13. In 2001. Switzerland (10.notably in the context of infectious disease.
in which systems. First is single payer. the greater problems with this approach have been the gradual deregulation of HMOs resulting in fewer of the promised choices for consumers. health care expenditures. most notably Minnesota. Second are employer or individual insurance mandates. 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 recent examples being the Massachusetts 2006 Health Reform Statute and Connecticut's SustiNet plan to provide quality. revolve around the use of private finance initiatives to build hospitals which it is argued costs taxpayers more in the long run. consumers. The scale. Over the past thirty years. state.Social health insurance is where a nation's entire population is eligible for health care coverage. and funding of these private systems is variable. In contrast. much as the current system operates. Current concerns in England. 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. with proposals currently underway to integrate these systems in various ways to provide a number of health care options. concerns are more based on the rising cost of drugs to the governments. 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. The medical model of health focuses on the eradication of illness through diagnosis and effective treatment. and usually for-profit. Private sources account for the remainder of costs. state or municipality with a government health care system a parallel private. for instance. Politics Main article: Health policy The politics of health care depends largely on which country one is in. In Brazil. and this coverage and the services provided are regulated. Finally. 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. an important political issue . a term meant to describe a single agency managing a single system. In almost every country. This is sometimes referred to as two-tier health care. extent. 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. Health system reform in the United States usually focuses around three suggested systems. This is argued[by whom?] to provide a greater incentive to find cost-saving health care approaches. Massachusetts and Connecticut. 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. In Germany and France. as found in most modernized countries as well as some states and municipalities within the United States. and local) account for 45% of U. affordable health care to state residents. Critics of consumer-driven health say that it would benefit the healthy but be insufficient for the chronically sick.S. Government sources (federal. A traditional view is that improvements in health result from advancements in medical science. and patients have more control of how they access care. The United States currently operates under a mixed market health care system. A few states have taken serious steps toward universal health care coverage. with which the state of Massachusetts has experimented. 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 some countries. and costs associated with the US health care system.  In contrast. or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. religious. Dennis Kucinich.  (In contrast.  However. trade unions. charities. To tackle the problems of the perpetually increasing number of uninsured. However. Health care by country Health care systems are designed to meet the health care needs of target populations. 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.is the breach of intellectual property rights. whose population sets the record for HIV infections. New York Times opinion columnist Paul Krugman said that Obama's plan would not actually provide universal coverage. whereas in others planning is made more centrally among governments. State boards and the Department of Health regulate inpatient care to reduce the national health care deficit. The South African government. an early candidate who did not get on the ballot.org alleges that Obama's predicted savings were exaggerated.) Factcheck. In the United States 12% to 16% of the citizens are still unable to afford health insurance. supported a single-payer system. or patents. President Barack Obama says he favors the creation of a universal health care system. for the domestic manufacture of antiretroviral drugs used in the treatment of HIV/AIDS. . the state of Oregon and the city of San Francisco are both examples of governments that adopted universal healthcare systems for strictly fiscal reasons. health care planning has often been evolutionary rather than revolutionary. There are a wide variety of health care systems around the world.
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