This action might not be possible to undo. Are you sure you want to continue?
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
Home > Library > Health > Public Health Encyclopedia
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
and other complex procedures require specialized medical teams.g. Prices. the disabled. yet the time expended is the same. especially hospitals. Closures leave the very old. 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. access public or charitable subsidization in order to remain economically viable. The lower the population density and the larger the area over which the population is distributed. the fewer the available health services and the longer the travel distances to access these services. Practice locations include publicly or charitably subsidized comprehensive primary-care centers or categorical service clinics (e. family planning. artery repair. advanced trauma care. a home health nurse may visit five patients in a morning within an urban apartment building. cannot afford the equipment and personnel necessary to treat the entire array of modern disease and injury. prenatal care. 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 the poor with no access to hospital inpatient care. People with financial resources and the ability to travel tend to use distant urban centers even for less complex needs. the ability of people to get to those services. Because of the distances between service locations or patient residences. Reduced fees and the refusal of insurers to pay for care often destabilize private professional practices in rural areas. Physician shortages are most visible in primary prevention. especially home-based or mobile services. physician assistants. The urban nurse will be reimbursed for five visits and the rural nurse for two. and treatment. However. Accessing complex care in urban medical centers often generates a patient perception that all rural hospital care is of lower quality. churches. and the entire community is left with no access to urgent or emergency care. and the economic viability of the services. immunizations) situated in central locations. Such resources are economically viable only in hospitals and surgical centers with high volumes of patients. or schools. Small rural health care providers. Consequently. and market forces contribute to the economic destabilization of many rural health care systems. Coronary bypass surgery. Low population density and greater travel times and barriers in rural areas affect service availability. and facilities. Lower population density also means a lower volume of patients and less provider income. leading to greater shortages of personnel. equipment. and in patient's homes. such as health departments.. mobile clinics. public and private insurers must struggle to control their expenditures. For example. for services include the minimum estimated cost of providing each service. rural residents must often travel great distances to access more costly and complex levels of care. Advances in medical technology.prepared to practice in rural environments. Primary care may be provided by nurse practitioners. or home-health nurses. rural communities suffer chronic physician shortages. Public health systems and an array of alternative primarycare providers often fill in the gaps. In addition. diagnosis. Consequently. As costs increase. Price controls most severely affect rural health systems. spending most of the time traveling. therefore. the cost per unit of service is often many times greater than in urban locations. increasing costs. the area suffers from the significant loss of employment. Home-based services in rural areas must. this strategy often fails and the hospital must close. or fee scales. while a nurse in a rural setting may visit only one or two patients. Emergency medical services in such areas are scattered over great distances and often staffed . Neither of these populations generates reimbursements adequate to cover the costs of services.
private insurance. causing increased morbidity and mortality. primary care physicians. in hospitals. or Medicaid) and how much money is spent on medical care. such as psychiatry and dermatology. and alternative practitioners) and whether they are practicing as individuals. reflecting the different cultural values and mores of those societies. in large groups. almost all physicians engaged in "general practice"—the provision of medical and surgical care for all diseases and for all patients. and Great Britain follow similar medical practices. specialist physicians." whereby they practiced by themselves without . Of particular interest to a health care system is how medical care is organized. Typically. such as stroke and heart attack. However. in small groups. magnify the effects of distance. Prenatal Care. Medicare. urban. 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. For instance. health care systems reflect the changing scientific and technologic nature of medical practice. Poor roads or geographic barriers. or in massive corporate organizations. Thus. financed. The organization of care refers to such issues as who gives care (for example. Primary Care. doctors engaged in "solo practice. Canada. Traditional Medical Practice in America For the first century of the republic. More remote areas with the capacity to pay for the technology. or various types of outpatient clinics. and delivered. France. Migrant Workers. Poverty and Health. self-pay. (SEE ALSO: Immunizations. are not fixed but are continually evolving. are beginning to use telemedicine to improve access for primary care and certain specialty care. or suburban locations). doctors' offices. may take longer to arrive than in other areas. nurses. Health care systems. The financing of care involves who pays for medical services (for example. Germany. the rise of modern surgery in the late nineteenth and early twentieth centuries helped create the modern hospital in the United States and helped lead to the concentration of so many medical and surgical services in hospital settings. The delivery of care refers to how and where medical services are provided (for example.with volunteers who have other jobs. but the health care systems of these nations vary considerably. such as mountains or rivers. Prevention. In part. ISAAC. and in rural. regardless of sex and age. such as western Kansas. physicians in the United States. HEATHER REED US History Encyclopedia: Health Care Top Home > Library > History. A country's health care system also reflects in part the culture and values of that society. Public Health Nursing) — SUSAN W. Emergency care for severe trauma or major acute illnesses. 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. like medical knowledge and medical practice.
partners. (Some medical specialists earned much more. safer childbirth. there were 661 hospitals in the United States containing in aggregate about 30.) Most physicians continued in solo.S. and many effective new drugs and operations—the cultural authority of doctors continued to grow.S. doctors were increasingly found in larger metropolises. and large wards for indigent patients where as many as thirty or forty "charity" patients would be housed together in one wide open room. In many hospitals and clinics. By 1930. where larger concentrations of patients could be found. the number of acute care hospitals had increased to around 7. the U.000. hormones. childbirth. Competition for patients from alternative healers diminished. and by 1940 formal certifying boards in the major clinical specialties had been established. and most Americans thought of consulting a doctor if they needed medical services. Indeed. fee-for-service practice. on average. or pharmacy. Doctors also experienced vigorous competition for patients from a variety of alternative or lay healers like Thomsonians. and together they contained about one million beds. and health care was not yet considered a fundamental right. Table 1 Specialization in Medicine American Board of Ophthalmology American Board of Pediatrics 191 6 193 3 . and faith healers. The location of care moved to doctors' offices for routine illnesses and to hospitals for surgery. and doctors often received payment in kind—a chicken or box of fruit rather than money. Since most hospitals were concentrated in cities and large towns. homeopaths. a "two-tiered" system of health care officially existed—private rooms in hospitals for paying patients. about 75 to 80 percent of doctors continued to engage in general practice. competition to "regular medicine" from alternative healers had markedly slackened. However. was not high. fueled by the growing results of scientific research and the resultant transformation of medical practice—antibiotics. Decade by decade. fueled by the revolution in medical science (particularly the rise of bacteriology and modern surgery). and major medical problems. Doctors would give patients a bill. vitamins. population was still 50 percent rural." In 1875. and patients would pay out of pocket. and it was common for doctors to have a second business like a farm. Before World War II (1939–1945). Medicine at this time was not an easy way for an individual to earn a living. Doctors' offices were typically at their homes or farms. Many physicians could not be kept busy practicing medicine. the technologic capacity and cultural authority of physicians in the United States began to escalate. particularly in the South. but already 80 percent of physicians resided in cities or large towns. and the average U. House calls were common. Physician income. antiseizure medications. the hospital came to be considered the "doctor's workshop. specialty medicine was already becoming prominent. hospital wards were segregated by race. Reflecting the rural makeup of the country. general store. most physicians resided in rural settings. By 1940. Payment was on the "fee-for-service" basis. Residency programs in the clinical specialties had been created. In the 1920s.000 beds. physician earned 2½ times the income of the average worker. In the last quarter of the nineteenth century and first quarter of the twentieth century. As one manifestation of this phenomenon.
Powerful diagnostic tools were developed. Equally impressive therapeutic procedures came into use. and nuclear magnetic resonance imaging. 1945–1985 The four decades following World War II witnessed even more extraordinary advances in the ability of medical care to prevent and relieve suffering. computerized tomography. chronic diseases such as cancer.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 . By midcentury. hip replacements. mechanical ventilators. New vaccines. In 1900. were developed. antihypertensive drugs. and by the end of the century life expectancy in the United States had increased about 30 years from that of 1900. radioimmunoassays. most notably the polio vaccine. such as newer and more powerful antibiotics. immunosuppressants. corticosteroids. and a variety of organ transplantations. stroke. average life expectancy in the United States was forty-seven years. openheart surgery. and heart attacks had replaced infections as the major causes of death. and the major causes of death each year were various infections. kidney dialysis machines. such as automated chemistry analyzers.
unable to switch to a better job because of the loss of health care benefits if they did so. In the fifteen years following the passage of Medicare and Medicaid. Fewer and fewer doctors were engaged in solo practice. hospitals. resulted in profound changes in the country's health care delivery system.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. 1950s. compared with only 10 percent who worried about the quality of care. when and how to turn off an artificial life-support device. 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. together with the development of the civil rights movement after World War II. Tens of millions of Americans still did not have access to health care. Before the war. most American physicians were still general practitioners." which was estimated to be two to four times as much as in other Western industrialized nations. that number had climbed to around 48 million. stunned many Americans by pointing out that U.) Many patients and health policy experts complained of the fragmentation of services that resulted from increasing specialization. the number of uninsured Americans was estimated at 40 million. 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. Table 2 . health care system became inundated with paperwork and "red tape. In the 1940s. not merely a privilege. the health care system was under increasing stress.S. others argued that there was an overemphasis on disease treatment and a relative neglect of disease prevention and health promotion. private medical insurance companies like Blue Cross/Blue Shield began providing health care insurance to millions of middle-class citizens. for institutions with segregated wards were ineligible to receive federal payments. 85 to 90 percent of medical graduates were choosing careers in specialty or subspecialty medicine. how to preserve patient autonomy and to obtain proper informed consent for clinical care or research trials. automobile companies were spending more per car on health premiums for workers than for the steel that went into the automobiles. When he left office in 2001. the most critical problem of the health care system was soaring costs. This change in attitude was financed by the rise of "third-party payers" that brought more and more Americans into the health care system. And the scientific and technological advances of medicine created a host of unprecedented ethical issues: the meaning of life and death. 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. these problems seemed even more insurmountable. Medicare and Medicaid also brought to an end the era of segregation at U. however. instead. The increasingly complicated U. for they were competing with foreign companies that paid far less for employee health insurance than they did. For providers of medical care. Millions of Americans became unwillingly tied to their employers. this meant unprecedented financial prosperity and minimal interference by payers in medical decision-making. Lee Iacocca. In the era of the soaring federal budget deficits of the Reagan administration. by 1960. These exceptional scientific accomplishments.S. however. Employers found their competitiveness in the global market to be compromised. (When President Bill Clinton assumed office in 1993. To most observers. Public opinion polls of the early 1980s revealed that 60 percent of the population worried about health care costs. and health care costs rose from 6 percent to 9 percent of the country's gross domestic product (GDP).S. expenditures on health care in dollars increased nearly sixfold. while president of Chrysler in the late 1970s. Despite these accomplishments. In 1965.
) 6 percent $230 billion 9 percent $1. better parking and more palatable hospital food). there have been serious drawbacks to managed care that in the view of many observers have outweighed its accomplishments.U. and it has stimulated the use of modern information technologies and business practices in the U.2 trillion 14 percent The Managed Care Era. the twenty-first century has . led to the business-imposed approach of "managed care." Ironically. the country once again faced double-digit health care inflation. Any cost savings that were achieved were considered a secondary benefit.7 billion 4. coupled with the inability of federal regulations and the medical profession on its own to achieve any meaningful cost control. However. In addition. and the requirement that patients be allowed to see specialists only if referred by a "gatekeeper. and in the early years of President George Walker Bush's administration. when that can be done safely. the attempt to control costs had become the dominant force underlying the managed care movement. it has encouraged greater attention to patients as consumers (for example. Unquestionably. and teaching hospitals. Health Care Costs Dollars 1950 1965 1980 2000 Percentage of GDP $12. however. severe restrictions on the length of time a patient may remain in the hospital. Examples of such cost-savings strategies include the requirement that physicians prescribe drugs only on a plan's approved formulary. in contrast to the "hands off" style of traditional feefor-service payment.5 percent $40 billion (est." allegedly serving patients but in fact refusing them needed tests and procedures in order to save money for the employing organization or insurance company.S. had been organized in the 1930s to achieve better coordination and continuity of care and to emphasize preventive medical services. Kaiser Permanente. 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. soaring medical care costs. the managed care movement has encouraged physicians to move many treatments and procedures from hospitals to less costly ambulatory settings. mandated preauthorizations before hospitalization or surgery. the managed care movement has brought much good. It has forced the medical profession for the first time to think seriously about costs. medical schools. As a result.S." "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. Managed care has not kept its promise of controlling health care costs. the first health maintenance organization. and the dollar-dominated medical marketplace has been highly injurious to medical education. By the 1980s. the emphasis on cost containment has come at the erosion of the quality of care. 1985–present In the mid-1980s. health care system. In the view of many.
Future Challenges The U. responsible health care delivery system in the United States at a more affordable price. In the twenty-first century. since 90 percent of managed care organizations are investor-owned companies. the for-profit problem is highly significant. the American public must be wise and courageous enough to maintain realistic expectations of medicine.S. Any efforts at cost containment must continue to be appropriately balanced with efforts to maintain high quality and patient advocacy in medical care. Better access to the system must also be provided. ready access to the system.S. and recognizing that individuals must assume responsibility for their own health by choosing a healthy lifestyle. However. Bibliography . This can be done by recognizing the broad determinants of health like good education and meaningful employment opportunities. doctors. Clearly. and affordable costs. Yet the wiser and more efficient use of resources is only one challenge to our country's health care system." a profligate American practice style in which many doctors often perform unnecessary tests and procedures. Thus. the country will still face the problem of limited resources and seemingly limitless demand. the inflationary consequences of having a "third party" pay the bill (thereby removing incentives from both doctors and patients to conserve dollars). seek to minimize what they call the "medical loss"—the portion of the health care premium that is actually used for health care. health care system. other causes of soaring health care costs are clearly less defensible. At some point hard decisions will have to be made about what services will and will not be paid for. clinics. Instead of spending 95 percent of their premiums on health care (a "medical loss" of 95 percent)." Ironically. health care system consider the for-profit motive in the delivery of medical services—rather than managed care per se—the more serious problem.opened with a significant public backlash against managed care and a vociferous "patients' rights movement. The practical problem in health care policy is that the pursuit of any two of these goals aggravates the third. there is much room to operate a more efficient. However. health care system has three primary goals: the provision of high-quality care. retain about 5 percent of the health premiums they receive for administrative and capital expenses and use the remaining 95 percent to provide health care for enrollees. in contrast. avoiding the "medicalization" of social ills like crime and drug addiction. a litigious culture that results in the high price of "defensive medicine. Lastly. These include the high administrative costs of the U. Certain causes of health care inflation are desirable and inevitable: an aging population and the development of new drugs and technologies. while a low-cost system available to everyone is likely to be achieved at the price of diminishing quality. a more accessible system of highquality care will tend to lead to higher costs. they spend only 80. such as Kaiser Permanente. retaining the rest for the financial benefit of executives and investors. 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. Nonprofit managed care organizations. 70. or even 60 percent of the premiums on health services. For-profit managed care companies. Medical insurance alone will not solve the health problems of a poor urban community where there are no hospitals. Some astute observers of the U. 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.S. or pharmacies. 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.
The Structure of American Medical Practice. Hiatt. see Health care (disambiguation). Cambridge. Princeton. Starr. The Profit Motive and Patient Care: The Changing Accountability of Doctors and Hospitals. New York: Oxford University Press. Marc A. 2000. Edited by Charles E. New York: Basic Books. New York: Basic Books. The Care of Strangers: The Rise of America's Hospital System. Ludmerer. George D. Rosemary. 1986. N. 1993.: Harvard University Press. 1911– 1965. Health Politics: The British and American Experience. Gray. Victor R. Kenneth M. N.J. Money. The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry. 1982. In Sickness and in Wealth: America's Hospitals in the Twentieth Century.J. Rodwin. New York: Oxford University Press. New York: Basic Books.: Princeton University Press. Stevens. Howard H. George. 1983. Daniel M. 1987. Rosenberg. Severed Trust: Why American Medicine Hasn't Been Fixed. 1991. Rosen. Medicine. Mass. Wikipedia: Health care Top Home > Library > Miscellaneous > Wikipedia This article has been nominated to be checked for its neutrality. Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. 1875–1941. 1986. Discussion of this nomination can be found on the talk page. 1999. Fuchs. 1987. Mechanic. 1989. (November 2009) For other uses. Mass. Philadelphia: University of Pennsylvania Press.: Rutgers University Press. Painful Choices: Research and Essays on Health Care. The Health Economy.Fox.: Harvard University Press. America's Health in the Balance: Choice or Chance? New York: Harper and Row. . Lundberg. Charles E. and Morals: Physicians' Conflicts of Interest. David. Paul. Health Policies. Cambridge. 1989. New York: Basic Books. Bradford H. New Brunswick. Rosenberg.
difficult and expensive procedures in medicine. Before the term health care became popular." Albany Times-Union November 12. -promoting or -maintaining behaviours. 2009</ref>. Health care (often healthcare in British English). and health insurance is a business which both provides and restricts reimbursement for healthcare itself in the event of disease. The International Red Cross and Red Crescent Movement is a well-known international relief movement. and the preservation of health through services offered by the medical. or in access to of medical healthcare in individual health-seeking. nursing. pharmaceutical.Surgery one of the most invasive. Contents [hide] • • • • • • 1 Health-care industry 2 Research ○ 2. whether directed to individuals or to populations”. Health care embraces all the goods and services designed to promote health. The definition of to recognize. English-speakers referred to medicine or to the health sector and spoke of the treatment and prevention of illness and disease. curative and palliative interventions. tough to define. is the treatment and management of illnesses of the elderly. The public health is related most to economic development and wealth distribution. and allied health professions.1 World Health Organization 3 Economics 4 Systems 5 Politics 6 Health care by country . health insurance (reimbursement of health care costs). 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). complementary and alternative medicine. including “preventive. and the public health (the collective state and range of health in a population). dental. clinical sciences (in vitro diagnostics).
which are mostly based on the United Nations system. chiropractice. and back again. The particular sectors associated with these groups are: biotechnology. The last class consists of all activities for human health not performed by hospitals or by medical doctors or dentists. List of pharmaceutical sciences journals. and other human health activities. medical massage. and the Journal of the American Medical Association are more general journals.  Research See also: List of health care journals. A new paradigm to biomedical research is being termed translational research. the International Standard Industrial Classification. The health-care industry incorporates several sectors that are dedicated to providing services and products dedicated to improving the health of individuals.05bn in 2006) and there is less growth in European R&D spending. providers of health care plans and home health care. nursing homes. hospitals. health care generally consists of Hospital activities. or other para-medical practitioners in the field of optometry. occupational therapy. medical equipment and instruments. Biomedical research (or experimental medicine). which focuses on iterative feedback loops between the basic and clinical research domains to accelerate knowledge translation from the bedside to the bench. Medical and dental practice activities. is the basic research. drug manufacturers. ambulance. drug delivery. British Medical Journal. acupuncture. diagnostic laboratories. speech therapy. List of bioinformatics journals. music therapy. nursing home. The latter is termed preclinical research if its goal is specifically to elaborate knowledge for the development of new therapeutic strategies. . 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. This involves activities of.50bn compared to €27. hydrotherapy. nurses. or translational research conducted to aid the body of knowledge in the field of medicine. In terms of pharmaceutical R&D spending. Europe spends a little less that the United States (€22. in general simply known as medical research. biotechnology & life sciences. applied research.  According to government classifications of Industry. scientific or diagnostic laboratiories. etc. diagnostic substances. pathology clinics. physiotherapists. and Medical literature Top impact factor academic journals in the health care field include Health Affairs and Milbank Quarterly.• • • 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. 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. The New England Journal of Medicine. midwives. and all other research that contributes to the development of new treatments. List of medical journals. homeopathy. chiropody. or under the supervision of.
other UN organizations.the first disease in history to be completely eliminated by deliberate human design. 2006. and the private sector (including pharmaceutical companies). Uncertainty is intrinsic to health. Broadly. often credited with giving rise to the health economics as a discipline. In 1979 the WHO declared that the disease had been eradicated . foundations and NGOs. and to promote the general health of the peoples of the world. especially key infectious diseases. making it an international standard. the agency inherited the mandate and resources of its predecessor. the United States dominates the biopharmaceutical field. accounting for the three quarters of the world’s biotechnology revenues and 80% of world R&D spending in biotechnology. Externalities arise frequently when considering health and health care.  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 Health Organization. Switzerland. Examples of its work include years of fighting smallpox. now exceed that of assessed contributions (dues) from its 193 member nations. these imbalances lead to market failures resulting from asymmetric information. asymmetric information. which had been an agency of the League of Nations. and headquartered in Geneva. Voluntary contributions to the WHO from national and local governments. drew conceptual distinctions between health and other goals. The WHO is financed by contributions from member states and from donors. and externalities. . both in patient outcomes and financial concerns. Factors that distinguish health economics from other areas include extensive government intervention. Governments tend to regulate the health care industry heavily and also tend to be the largest payer within the market.  World Health Organization Main article: World Health Organization See also: Global health The World Health Organization (WHO) is a specialized United Nations agency which acts as a coordinator and researcher for public health around the world. The WHO's constitution states that its mission "is the attainment by all peoples of the highest possible level of health. with NGOs and the pharmaceutical industry. intractable uncertainty in several dimensions. In recent years the WHO's work has involved more collaboration. Established on 7 April 1948. The organization has already endorsed the world's first official HIV/AIDS Toolkit for Zimbabwe from October 3. health economists study the functioning of the health care system and the private and social causes of health-affecting behaviors such as smoking. currently around 80 such partnerships. as well as with foundations such as the Bill and Melinda Gates Foundation and the Rockefeller Foundation." Its major task is to combat disease. A seminal 1963 article by Kenneth Arrow. The WHO is nearing success in developing vaccines against malaria and schistosomiasis and aims to eradicate polio within the next few years. 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. Pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States.
notably in the context of infectious disease. health care can form an enormous part of a country's economy. Systems A group of Chilean 'Damas de Rojo'.4 per cent of GDP across the OECD countries with the United States (13. Planning. For example. affects people other than the decision maker. In 2001.9%). while Europe. United States accounts for the three quarters of the world’s biotechnology revenues. and Germany (10. 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. respectively. Main article: Health care system See also: Preventive medicine and Social medicine .7%) being the top three. budgeting and monitoring mechanisms. and. and all other nations account for 30%.9%). 9%. volunteers on their local hospital. and 13%. Consuming just under 10 percent of gross domestic product of most developed nations. making an effort to avoid catching a cold. The United States and Canada account for 48% of world pharmaceutical sales. health care consumed 8. or practising safer sex. Japan. Switzerland (10.
 In Germany and France. The scale. A few states have taken serious steps toward universal health care coverage.Social health insurance is where a nation's entire population is eligible for health care coverage. Critics of consumer-driven health say that it would benefit the healthy but be insufficient for the chronically sick. Second are employer or individual insurance mandates.S. state. Over the past thirty years. with recent examples being the Massachusetts 2006 Health Reform Statute and Connecticut's SustiNet plan to provide quality. Health system reform in the United States usually focuses around three suggested systems. In Brazil. with proposals currently underway to integrate these systems in various ways to provide a number of health care options. In almost every country. First is single payer. This is sometimes referred to as two-tier health care. and funding of these private systems is variable. Private sources account for the remainder of costs. 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. there is consumer-driven health. as found in most modernized countries as well as some states and municipalities within the United States. 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 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. Massachusetts and Connecticut. with which the state of Massachusetts has experimented. in which systems. 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 United States currently operates under a mixed market health care system. revolve around the use of private finance initiatives to build hospitals which it is argued costs taxpayers more in the long run. affordable health care to state residents. they have less short and mediumterm incentives than private agents to make purchases that can generate revenues and avoid bankruptcy. most notably Minnesota. This is argued[by whom?] to provide a greater incentive to find cost-saving health care approaches. 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. and usually for-profit. an important political issue . The medical model of health focuses on the eradication of illness through diagnosis and effective treatment. health care expenditures. A traditional view is that improvements in health result from advancements in medical science. 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. much as the current system operates. Government sources (federal. and patients have more control of how they access care. 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. and this coverage and the services provided are regulated. for instance. the greater problems with this approach have been the gradual deregulation of HMOs resulting in fewer of the promised choices for consumers. a term meant to describe a single agency managing a single system. extent. In contrast. Current concerns in England. concerns are more based on the rising cost of drugs to the governments. Finally. consumers. state or municipality with a government health care system a parallel private.
The South African government. However. an early candidate who did not get on the ballot. whereas in others planning is made more centrally among governments.  In contrast. or patents. .org alleges that Obama's predicted savings were exaggerated.) Factcheck. health care planning has often been evolutionary rather than revolutionary.  However. charities. supported a single-payer system. trade unions. and costs associated with the US health care system. or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. In some countries. for the domestic manufacture of antiretroviral drugs used in the treatment of HIV/AIDS. In the United States 12% to 16% of the citizens are still unable to afford health insurance. the health care system planning is distributed among market participants. New York Times opinion columnist Paul Krugman said that Obama's plan would not actually provide universal coverage. whose population sets the record for HIV infections. Dennis Kucinich.  (In contrast. To tackle the problems of the perpetually increasing number of uninsured. the state of Oregon and the city of San Francisco are both examples of governments that adopted universal healthcare systems for strictly fiscal reasons. There are a wide variety of health care systems around the world. State boards and the Department of Health regulate inpatient care to reduce the national health care deficit.is the breach of intellectual property rights. Health care by country Health care systems are designed to meet the health care needs of target populations. President Barack Obama says he favors the creation of a universal health care system. religious. came under pressure for its refusal to admit there is any connection with AIDS because of the cost it would have involved.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue reading from where you left off, or restart the preview.