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