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