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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

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

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

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

and heart attacks had replaced infections as the major causes of death. and by the end of the century life expectancy in the United States had increased about 30 years from that of 1900. hip replacements. such as automated chemistry analyzers. chronic diseases such as cancer. mechanical ventilators. such as newer and more powerful antibiotics. were developed. and nuclear magnetic resonance imaging. immunosuppressants. stroke. corticosteroids. By midcentury. average life expectancy in the United States was forty-seven years. computerized tomography. 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. most notably the polio vaccine. In 1900. Powerful diagnostic tools were developed. and a variety of organ transplantations. and the major causes of death each year were various infections. Equally impressive therapeutic procedures came into use. openheart surgery. kidney dialysis machines. radioimmunoassays.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. Most Americans now faced the . antihypertensive drugs. New vaccines.

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

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

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

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

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

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

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

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

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

New York Times opinion columnist Paul Krugman said that Obama's plan would not actually provide universal coverage. [22] (In contrast. supported a single-payer system. came under pressure for its refusal to admit there is any connection with AIDS[20] because of the cost it would have involved. health care planning has often been evolutionary rather than revolutionary.is the breach of intellectual property rights. State boards and the Department of Health regulate inpatient care to reduce the national health care deficit. whereas in others planning is made more centrally among governments. the health care system planning is distributed among market participants. Health care by country Health care systems are designed to meet the health care needs of target populations. the state of Oregon and the city of San Francisco are both examples of governments that adopted universal healthcare systems for strictly fiscal reasons. However. religious.org alleges that Obama's predicted savings were exaggerated. an early candidate who did not get on the ballot. [21] However. 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. There are a wide variety of health care systems around the world. or patents.) Factcheck. In some countries. In the United States 12% to 16% of the citizens are still unable to afford health insurance. To tackle the problems of the perpetually increasing number of uninsured. whose population sets the record for HIV infections. Dennis Kucinich. charities. The South African government. trade unions. and costs associated with the US health care system. . [23] In contrast. or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve.

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