Health care

Health care or healthcare is the maintenance or improvement of health via the prevention, diagnosis, and treatment of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals (providers or practitioners) in allied health fields. Physicians and physician associates are a part of these health professionals. Dentistry, midwifery, nursing, medicine, optometry, audiology, pharmacy, psychology, occupational therapy, physical therapy and other health professions are all part of health care. It includes work done in providing primary care, secondary care, and tertiary care, as well as in public health.

Access to health care may vary across countries, communities, and individuals, largely influenced by social and economic conditions as well as health policies. Health care systems are organizations established to meet the health needs of targeted populations. According to the World Health Organization (WHO), a well-functioning health care system requires a financing mechanism, a well-trained and adequately paid workforce, reliable information on which to base decisions and policies, and well maintained health facilities to deliver quality medicines and technologies.[1]

An efficient health care system can contribute to a significant part of a country's economy, development and industrialization. Health care is conventionally regarded as an important determinant in promoting the general physical and mental health and well-being of people around the world. An example of this was the worldwide eradication of smallpox in 1980, declared by the WHO as the first disease in human history to be completely eliminated by deliberate health care interventions.[2]

NewYorkPresbyterian-Cornell
NewYork–Presbyterian Hospital in New York City is one of the world's busiest hospitals. Pictured is the Weill-Cornell facility (white complex at the center).

Delivery

Jericho Health Centre 20050326
Primary care may be provided in community health centers.

The delivery of modern health care depends on groups of trained professionals and paraprofessionals coming together as interdisciplinary teams.[3] This includes professionals in medicine, psychology, physiotherapy, nursing, dentistry, midwifery and allied health, along with many others such as public health practitioners, community health workers and assistive personnel, who systematically provide personal and population-based preventive, curative and rehabilitative care services.

While the definitions of the various types of health care vary depending on the different cultural, political, organizational and disciplinary perspectives, there appears to be some consensus that primary care constitutes the first element of a continuing health care process and may also include the provision of secondary and tertiary levels of care.[4] Health care can be defined as either public or private.

FEMA - 18213 - Photograph by Robert Kaufmann taken on 10-25-2005 in Louisiana
The emergency room is often a frontline venue for the delivery of primary medical care.

Primary care

Terapevt Mudrov train
Medical train "Therapist Matvei Mudrov" in Khabarovsk, Russia[5]

Primary care refers to the work of health professionals who act as a first point of consultation for all patients within the health care system.[4][6] Such a professional would usually be a primary care physician, such as a general practitioner or family physician. Another professional would be a licensed independent practitioner such as a physiotherapist, or a non-physician primary care provider such as a physician assistant or nurse practitioner. Depending on the locality, health system organization the patient may see another health care professional first, such as a pharmacist or nurse. Depending on the nature of the health condition, patients may be referred for secondary or tertiary care.

Primary care is often used as the term for the health care services that play a role in the local community. It can be provided in different settings, such as Urgent care centers which provide same day appointments or services on a walk-in basis.

Primary care involves the widest scope of health care, including all ages of patients, patients of all socioeconomic and geographic origins, patients seeking to maintain optimal health, and patients with all types of acute and chronic physical, mental and social health issues, including multiple chronic diseases. Consequently, a primary care practitioner must possess a wide breadth of knowledge in many areas. Continuity is a key characteristic of primary care, as patients usually prefer to consult the same practitioner for routine check-ups and preventive care, health education, and every time they require an initial consultation about a new health problem. The International Classification of Primary Care (ICPC) is a standardized tool for understanding and analyzing information on interventions in primary care based on the reason for the patient's visit.[7]

Common chronic illnesses usually treated in primary care may include, for example: hypertension, diabetes, asthma, COPD, depression and anxiety, back pain, arthritis or thyroid dysfunction. Primary care also includes many basic maternal and child health care services, such as family planning services and vaccinations. In the United States, the 2013 National Health Interview Survey found that skin disorders (42.7%), osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory tract disease (22.1%, excluding asthma) were the most common reasons for accessing a physician.[8]

In the United States, primary care physicians have begun to deliver primary care outside of the managed care (insurance-billing) system through direct primary care which is a subset of the more familiar concierge medicine. Physicians in this model bill patients directly for services, either on a pre-paid monthly, quarterly, or annual basis, or bill for each service in the office. Examples of direct primary care practices include Foundation Health in Colorado and Qliance in Washington.

In context of global population aging, with increasing numbers of older adults at greater risk of chronic non-communicable diseases, rapidly increasing demand for primary care services is expected in both developed and developing countries.[9][10] The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary health care strategy.[4]

Secondary care

Secondary care includes acute care: necessary treatment for a short period of time for a brief but serious illness, injury, or other health condition. This care is often found in a hospital emergency department. Secondary care also includes skilled attendance during childbirth, intensive care, and medical imaging services.

The term "secondary care" is sometimes used synonymously with "hospital care". However, many secondary care providers, such as psychiatrists, clinical psychologists, occupational therapists, most dental specialties or physiotherapists, do not necessarily work in hospitals. Some primary care services are delivered within hospitals. Depending on the organization and policies of the national health system, patients may be required to see a primary care provider for a referral before they can access secondary care.

In countries which operate under a mixed market health care system, some physicians limit their practice to secondary care by requiring patients to see a primary care provider first. This restriction may be imposed under the terms of the payment agreements in private or group health insurance plans. In other cases, medical specialists may see patients without a referral, and patients may decide whether self-referral is preferred.

In other countries patient self-referral to a medical specialist for secondary care is rare as prior referral from another physician (either a primary care physician or another specialist) is considered necessary, regardless of whether the funding is from private insurance schemes or national health insurance.

Allied health professionals, such as physical therapists, respiratory therapists, occupational therapists, speech therapists, and dietitians, also generally work in secondary care, accessed through either patient self-referral or through physician referral.

Tertiary care

NationalNeurologyHospital
The National Hospital for Neurology and Neurosurgery in London, United Kingdom is a specialist neurological hospital.

Tertiary care is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.[11]

Examples of tertiary care services are cancer management, neurosurgery, cardiac surgery, plastic surgery, treatment for severe burns, advanced neonatology services, palliative, and other complex medical and surgical interventions.[12]

Quaternary care

The term quaternary care is sometimes used as an extension of tertiary care in reference to advanced levels of medicine which are highly specialized and not widely accessed. Experimental medicine and some types of uncommon diagnostic or surgical procedures are considered quaternary care. These services are usually only offered in a limited number of regional or national health care centers.[12][13] Quaternary care is more prevalent in the United Kingdom.

Home and community care

Many types of health care interventions are delivered outside of health facilities. They include many interventions of public health interest, such as food safety surveillance, distribution of condoms and needle-exchange programs for the prevention of transmissible diseases.

They also include the services of professionals in residential and community settings in support of self care, home care, long-term care, assisted living, treatment for substance use disorders among other types of health and social care services.

Community rehabilitation services can assist with mobility and independence after loss of limbs or loss of function. This can include prosthesis, orthotics or wheelchairs.

Many countries, especially in the west, are dealing with aging populations, so one of the priorities of the health care system is to help seniors live full, independent lives in the comfort of their own homes. There is an entire section of health care geared to providing seniors with help in day-to-day activities at home such as transportation to and from doctor's appointments along with many other activities that are essential for their health and well-being. Although they provide home care for older adults in cooperation, family members and care workers may harbor diverging attitudes and values towards their joint efforts. This state of affairs presents a challenge for the design of ICT (information and communication technology) for home care.[14]

Because statistics show that over 80 million Americans have taken time off of their primary employment to care for a loved one,[15] many countries have begun offering programs such as Consumer Directed Personal Assistant Program to allow family members to take care of their loved ones without giving up their entire income.

With obesity in children rapidly becoming a major concern, health services often set up programs in schools aimed at educating children about nutritional eating habits, making physical education a requirement and teaching young adolescents to have positive self-image.

Ratings

Health care ratings are ratings or evaluations of health care used to evaluate the process of care and health care structures and/or outcomes of health care services. This information is translated into report cards that are generated by quality organizations, nonprofit, consumer groups and media. This evaluation of quality is based on measures of:

Related sectors

Health care extends beyond the delivery of services to patients, encompassing many related sectors, and is set within a bigger picture of financing and governance structures.

Health system

A health system, also sometimes referred to as health care system or healthcare system is the organization of people, institutions, and resources that deliver health care services to populations in need.

Health care industry

A group of Damas de Rojo
A group of Chilean 'Damas de Rojo' volunteering at their local hospital

The health care industry incorporates several sectors that are dedicated to providing health care services and products. As a basic framework for defining the sector, the United Nations' International Standard Industrial Classification categorizes health care as generally consisting of hospital activities, medical and dental practice activities, and "other human health activities." The last class involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics, residential health facilities, patient advocates[16] or other allied health professions.

In addition, according to industry and market classifications, such as the Global Industry Classification Standard and the Industry Classification Benchmark, health care includes many categories of medical equipment, instruments and services including biotechnology, diagnostic laboratories and substances, drug manufacturing and delivery.

For example, pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States.[17][18] The United States dominates the biopharmaceutical field, accounting for three-quarters of the world's biotechnology revenues.[17][19]

Health care research

The quantity and quality of many health care interventions are improved through the results of science, such as advanced through the medical model of health which focuses on the eradication of illness through diagnosis and effective treatment. Many important advances have been made through health research, biomedical research and pharmaceutical research, which form the basis for evidence-based medicine and evidence-based practice in health care delivery.

Health services research can lead to greater efficiency and equitable delivery of health care interventions, as advanced through the social model of health and disability, which emphasizes the societal changes that can be made to make populations healthier.[20] Results from health services research often form the basis of evidence-based policy in health care systems. Health services research is also aided by initiatives in the field of artificial intelligence for the development of systems of health assessment that are clinically useful, timely, sensitive to change, culturally sensitive, low burden, low cost, built into standard procedures, and involve the patient.[21]

Health care financing

There are generally five primary methods of funding health care systems:[22]

  1. general taxation to the state, county or municipality
  2. social health insurance
  3. voluntary or private health insurance
  4. out-of-pocket payments
  5. donations to health charities

In most countries there is a mix of all five models, but this varies across countries and over time within countries. Aside from financing mechanisms, an important question should always be how much to spend on healthcare. For the purposes of comparison, this is often expressed as the percentage of GDP spent on healthcare. In OECD countries for every extra $1000 spent on healthcare, life expectancy falls by 0.4 years. A similar correlation is seen from analysis carried out each year by Bloomberg. [23]Clearly this kind of analysis is flawed in that life expectancy is only one measure of a health system's performance, but equally, the notion that more funding is better is not supported.

In 2011, the health care industry consumed an average of 9.3 percent of the GDP or US$ 3,322 (PPP-adjusted) per capita across the 34 members of OECD countries. The US (17.7%, or US$ PPP 8,508), the Netherlands (11.9%, 5,099), France (11.6%, 4,118), Germany (11.3%, 4,495), Canada (11.2%, 5669), and Switzerland (11%, 5,634) were the top spenders, however life expectancy in total population at birth was highest in Switzerland (82.8 years), Japan and Italy (82.7), Spain and Iceland (82.4), France (82.2) and Australia (82.0), while OECD's average exceeds 80 years for the first time ever in 2011: 80.1 years, a gain of 10 years since 1970. The US (78.7 years) ranges only on place 26 among the 34 OECD member countries, but has the highest costs by far. All OECD countries have achieved universal (or almost universal) health coverage, except the US and Mexico.[24][25] (see also international comparisons.)

In the United States, where around 18% of GDP is spent on health care,[23] the Commonwealth Fund analysis of spend and quality shows a clear correlation between worse quality and higher spending.[26]

Administration and regulation

The management and administration of health care is vital to the delivery of health care services. In particular, the practice of health professionals and operation of health care institutions is typically regulated by national or state/provincial authorities through appropriate regulatory bodies for purposes of quality assurance.[27] Most countries have credentialing staff in regulatory boards or health departments who document the certification or licensing of health workers and their work history.[28]

Health information technology

Health information technology (HIT) is "the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making."[29]

Health information technology components:

  • Electronic Health Record (EHR) - An EHR contains a patient's comprehensive medical history, and may include records from multiple providers.[30]
  • Electronic Medical Record (EMR) - An EMR contains the standard medical and clinical data gathered in one's provider’s office.[30]
  • Personal Health Record (PHR) - A PHR is a patient's medical history that is maintained privately, for personal use.[31]
  • Medical Practice Management software (MPM) - is designed to streamline the day-to-day tasks of operating a medical facility. Also known as practice management software or practice management system (PMS).
  • Health Information Exchange (HIE) - Health Information Exchange allows health care professionals and patients to appropriately access and securely share a patient’s vital medical information electronically.[32]

See also

References

  1. ^ "Health Topics: Health Systems". www.who.int. World Health Organization. Retrieved 2013-11-24.
  2. ^ World Health Organization. Anniversary of smallpox eradication. Geneva, 18 June 2010.
  3. ^ United States Department of Labor. Employment and Training Administration: Health care. Retrieved June 24, 2011.
  4. ^ "June 2014". Magazine. Retrieved 9 March 2019.
  5. ^ World Health Organization. Definition of Terms. Retrieved 26 August 2014.
  6. ^ World Health Organization. International Classification of Primary Care, Second edition (ICPC-2). Geneva. Accessed 24 June 2011.
  7. ^ St Sauver JL, Warner DO, Yawn BP, et al. (January 2013). "Why patients visit their doctors: assessing the most prevalent conditions in a defined American population". Mayo Clin. Proc. 88 (1): 56–67. doi:10.1016/j.mayocp.2012.08.020. PMC 3564521. PMID 23274019.
  8. ^ World Health Organization. Aging and life course: Our aging world. Geneva. Accessed 24 June 2011.
  9. ^ Simmons J. Primary Care Needs New Innovations to Meet Growing Demands. HealthLeaders Media, May 27, 2009.
  10. ^ Johns Hopkins Medicine. Patient Care: Tertiary Care Definition. Accessed 27 June 2011.
  11. ^ a b Emory University. School of Medicine. Accessed 27 June 2011.
  12. ^ Alberta Physician Link. Levels of Care. Retrieved 26 August 2014.
  13. ^ Christensen, L.R.; E. Grönvall (2011). "Challenges and Opportunities for Collaborative Technologies for Home Care Work". S. Bødker, N. O. Bouvin, W. Letters, V. Wulf and L. Ciolfi (eds.) ECSCW 2011: Proceedings of the 12th European Conference on Computer Supported Cooperative Work, 24–28 September 2011, Aarhus, Denmark. Springer: 61–80. doi:10.1007/978-0-85729-913-0_4. ISBN 978-0-85729-912-3.
  14. ^ Porter, Eduardo (2017-08-29). "Home Health Care: Shouldn't It Be Work Worth Doing?". The New York Times. ISSN 0362-4331. Retrieved 2017-11-29.
  15. ^ Dorothy Kamaker. "Patient advocacy services ensure optimum health outcomes". Retrieved 2015-09-26.
  16. ^ a b "The Pharmaceutical Industry in Figures" (pdf). European Federation of Pharmaceutical Industries and Associations. 2007. Retrieved February 15, 2010.
  17. ^ "2008 Annual Report" (PDF). Pharmaceutical Research and Manufacturers of America. Retrieved February 15, 2010.
  18. ^ "Europe's competitiveness". European Federation of Pharmaceutical Industries and Associations. Archived from the original on 23 August 2009. Retrieved February 15, 2010.
  19. ^ Bond J.; Bond S. (1994). Sociology and Health Care. Churchill Livingstone. ISBN 978-0-443-04059-7.
  20. ^ Erik Cambria; Tim Benson; Chris Eckl; Amir Hussain (2012). "Sentic PROMs: Application of Sentic Computing to the Development of a Novel Unified Framework for Measuring Health-Care Quality". Expert Systems with Applications, Elsevier. doi:10.1016/j.eswa.2012.02.120.
  21. ^ World Health Organization. "Regional Overview of Social Health Insurance in South-East Asia.' Retrieved December 02, 2014.
  22. ^ a b "These Are the Economies With the Most (and Least) Efficient Health Care". BloombergQuint. Retrieved 2019-01-14.
  23. ^ "Health at a Glance 2013 - OECD Indicators" (PDF). OECD. 2013-11-21. pp. 5, 39, 46, 48. (link). Retrieved 2013-11-24.
  24. ^ "OECD.StatExtracts, Health, Health Status, Life expectancy, Total population at birth, 2011" (online statistics). stats.oecd.org/. OECD's iLibrary. 2013. Retrieved 2013-11-24.
  25. ^ "Health Care Quality-Spending Interactive | Commonwealth Fund". www.commonwealthfund.org. Retrieved 2019-01-14.
  26. ^ World Health Organization, 2003. Quality and accreditation in health care services. Geneva http://www.who.int/hrh/documents/en/quality_accreditation.pdf
  27. ^ Tulenko et al., "Framework and measurement issues for monitoring entry into the health workforce." Handbook on monitoring and evaluation of human resources for health. Geneva, World Health Organization, 2012.
  28. ^ "Health information technology — HIT". HealthIT.gov. Retrieved 5 August 2014.
  29. ^ a b "Definition and Benefits of Electronic Medical Records (EMR) | Providers & Professionals | HealthIT.gov". www.healthit.gov. Retrieved 2017-11-27.
  30. ^ "What is a personal health record? | FAQs | Providers & Professionals | HealthIT.gov". www.healthit.gov. Retrieved 2017-11-27.
  31. ^ "Official Information about Health Information Exchange (HIE) | Providers & Professionals | HealthIT.gov". www.healthit.gov. Retrieved 2017-11-27.
Allied health professions

Allied health professions are health care professions distinct from nursing, medicine, and pharmacy. They work in health care teams to make the health care system function by providing a range of diagnostic, technical, therapeutic and direct patient care and support services that are critical to the other health professionals they work with and the patients they serve.

Centers for Medicare and Medicaid Services

The Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities (more commonly referred to as nursing homes) through its survey and certification process, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of HealthCare.gov.

Chaplain

A chaplain is, traditionally, a cleric (such as a purohit, minister, priest, pastor, rabbi, or imam), or a lay representative of a religious tradition, attached to a secular institution such as a hospital, prison, military unit, school, labor union, business, police department, fire department, university, or private chapel.

Though originally the word chaplain referred to representatives of the Christian faith, it is now also applied to people of other religions or philosophical traditions, such as the case of chaplains serving with military forces and an increasing number of chaplaincies at American universities. In recent times, many lay people have received professional training in chaplaincy and are now appointed as chaplains in schools, hospitals, companies, universities, prisons and elsewhere to work alongside, or instead of, official members of the clergy. The concepts of a multi-faith team, secular, generic or humanist chaplaincy are also gaining increasing use, particularly within healthcare and educational settings.

Clinic

A clinic (or outpatient clinic or ambulatory care clinic) is a healthcare facility that is primarily focused on the care of outpatients. Clinics can be privately operated or publicly managed and funded. They typically cover the primary healthcare needs of populations in local communities, in contrast to larger hospitals which offer specialised treatments and admit inpatients for overnight stays.

Most commonly, the English word clinic refers to a general medical practice, run by one or more general practitioners, but it can also mean a specialist clinic. Some clinics retain the name "clinic" even while growing into institutions as large as major hospitals or becoming associated with a hospital or medical school.

Clinton health care plan of 1993

The Clinton health care plan was a 1993 healthcare reform package proposed by the administration of President Bill Clinton and closely associated with the chair of the task force devising the plan, First Lady of the United States Hillary Clinton.

The president had campaigned heavily on health care in the 1992 presidential election. The task force was created in January 1993, but its own processes were somewhat controversial and drew litigation. Its goal was to come up with a comprehensive plan to provide universal health care for all Americans, which was to be a cornerstone of the administration's first-term agenda. The president delivered a major health care speech to the US Congress in September 1993. During his speech he proposed an enforced mandate for employers to provide health insurance coverage to all of their employees.

Opposition to the plan was heavy from conservatives, libertarians, and the health insurance industry. The industry produced a highly effective television ad, "Harry and Louise", in an effort to rally public support against the plan.

Instead of uniting behind the original proposal, many Democrats offered a number of competing plans of their own. Hillary Clinton was drafted by the Clinton Administration to head a new Task Force and sell the plan to the American people, which ultimately backfired amid the barrage from the pharmaceutical and health insurance industries and considerably diminished her own popularity. On September 26, 1994, the final compromise Democratic bill was declared dead by Senate Majority Leader George J. Mitchell.

Health Insurance Portability and Accountability Act

The Health Insurance Portability and Accountability Act of 1996 (HIPAA; Pub.L. 104–191, 110 Stat. 1936, enacted August 21, 1996) was enacted by the United States Congress and signed by President Bill Clinton in 1996. It was created primarily to modernize the flow of healthcare information, stipulate how Personally Identifiable Information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft, and address limitations on healthcare insurance coverage. It has been known as the Kennedy–Kassebaum Act or Kassebaum–Kennedy Act after two of its leading sponsors. The Act consists of five Titles. Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. Title III sets guidelines for pre-tax medical spending accounts, Title IV sets guidelines for group health plans, and Title V governs company-owned life insurance policies.

Health care in Australia

Health care in Australia is delivered as a mixed system: universal health care (public) and private providers (insurance). Most health care is provided publicly (public hospitals and primary health care such as general practitioners), with the remaining provided by the private sector (private hospitals, allied health care such as physiotherapy and dental).

Medicare is Australia's universal health insurance scheme, which subsidises most medical costs in Australia for all Australian citizens and permanent residents. A number of other schemes cover the medical costs in specific circumstances, such as for veterans or indigenous Australians, motor vehicle insurance, and workers' compensation schemes. The current Medicare levy, paid by Australians who earn over a certain income, is 2%. Those who earn more pay an additional surcharge if they do not have private health insurance (Medicare Levy Surcharge).

Medical costs of visitors to Australia may be covered by travel insurance or under a reciprocal health agreement. People who are not covered by the Medicare scheme or wish to be covered for out-of-pocket medical or hospital costs can take out voluntary private health insurance, which is also subsidised by the federal government. In addition to Medicare, there is a separate Pharmaceutical Benefits Scheme funded by the federal government, which considerably subsidises a range of prescription medications.

Medicare is financed by a Medicare levy, which is compulsory and administered through the tax system. The federal Minister for Health, currently Greg Hunt, administers national health policy, and state and territory governments administer elements of health care within their jurisdictions, such as the operation of hospitals. The funding model for health care in Australia has seen political polarisation, with governments being crucial in shaping national health care policy.

Health care in the United States

Health care in the United States is provided by many distinct organizations. Health care facilities are largely owned and operated by private sector businesses. 58% of US community hospitals are non-profit, 21% are government owned, and 21% are for-profit. According to the World Health Organization (WHO), the United States spent $9,403 on health care per capita, and 17.1% on health care as percentage of its GDP in 2014. Healthcare coverage is provided through a combination of private health insurance and public health coverage (e.g., Medicare, Medicaid). The United States does not have a universal healthcare program, unlike other advanced industrialized countries.In 2013, 64% of health spending was paid for by the government, and funded via programs such as Medicare, Medicaid, the Children's Health Insurance Program, and the Veterans Health Administration. People aged under 65 acquire insurance via their or a family member's employer, by purchasing health insurance on their own, or are uninsured. Health insurance for public sector employees is primarily provided by the government in its role as employer.The United States life expectancy is 78.6 years at birth, up from 75.2 years in 1990; this ranks 42nd among 224 nations, and 22nd out of the 35 industrialized OECD countries, down from 20th in 1990. In 2016 and 2017 life expectancy in the U.S. dropped for the first time since 1993. Of 17 high-income countries studied by the National Institutes of Health, the United States in 2013 had the highest or near-highest prevalence of obesity, car accidents, infant mortality, heart and lung disease, sexually transmitted infections, adolescent pregnancies, injuries, and homicides. A 2014 survey of the healthcare systems of 11 developed countries found that the US healthcare system to be the most expensive and worst-performing in terms of health access, efficiency, and equity.Prohibitively high cost is the primary reason Americans have problems accessing health care. Consulting company Gallup recorded that the uninsured rate among U.S. adults was 11.9% for the first quarter of 2015, continuing the decline of the uninsured rate outset by the Patient Protection and Affordable Care Act (PPACA). At over 27 million, the number of people without health insurance coverage in the United States is one of the primary concerns raised by advocates of health care reform. Lack of health insurance is associated with increased mortality, about sixty thousand preventable deaths per year, depending on the study. A study done at Harvard Medical School with Cambridge Health Alliance showed that nearly 45,000 annual deaths are associated with a lack of patient health insurance. The study also found that uninsured, working Americans have an approximately 40% higher mortality risk compared to privately insured working Americans.In 2010, the Patient Protection and Affordable Care Act (PPACA) became law, enacting major changes in health insurance. The Supreme Court upheld the constitutionality of most of the law in June 2012 and affirmed insurance exchange subsidies in all states in June 2015.

Health economics

Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare. In broad terms, health economists study the functioning of healthcare systems and health-affecting behaviors such as smoking.

A seminal 1963 article by Kenneth Arrow, often credited with giving rise to health economics as a discipline, drew conceptual distinctions between health and other goods.

Factors that distinguish health economics from other areas include extensive government intervention, intractable uncertainty in several dimensions, asymmetric information, barriers to entry, externalities and the presence of a third-party agent. In healthcare, the third-party agent is the physician, who makes purchasing decisions (e.g., whether to order a lab test, prescribe a medication, perform a surgery, etc.) while being insulated from the price of the product or service.

Health economists evaluate multiple types of financial information: costs, charges and expenditures.

Uncertainty is intrinsic to health, both in patient outcomes and financial concerns. The knowledge gap that exists between a physician and a patient creates a situation of distinct advantage for the physician, which is called asymmetric information.

Externalities arise frequently when considering health and health care, notably in the context of infectious disease. For example, making an effort to avoid catching the common cold affects people other than the decision maker.

Health policy

Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society". According to the World Health Organization, an explicit health policy can achieve several things: it defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people.There are many categories of health policies, including global health policy, public health policy, mental health policy, health care services policy, insurance policy, personal healthcare policy, pharmaceutical policy, and policies related to public health such as vaccination policy, tobacco control policy or breastfeeding promotion policy. They may cover topics of financing and delivery of healthcare, access to care, quality of care, and health equity.

Health professional

A health professional may operate within all branches of health care, including medicine, surgery, dentistry, midwifery, pharmacy, psychology, nursing or allied health professions. A health professional may also be a public/community health expert working for the common good of the society.

Health system

A health system, also sometimes referred to as health care system or as healthcare system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.

There is a wide variety of health systems around the world, with as many histories and organizational structures as there are nations. Implicitly, nations must design and develop health systems in accordance with their needs and resources, although common elements in virtually all health systems are primary healthcare and public health measures. In some countries, health system planning is distributed among market participants. In others, there is a concerted effort among governments, trade unions, charities, religious organizations, or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has been described as often evolutionary rather than revolutionary.

Healthcare in Canada

Healthcare in Canada is delivered through thirteen provincial and territorial systems of publicly funded health care, informally called Medicare. It is guided by the provisions of the Canada Health Act of 1984.

Healthcare industry

The healthcare industry (also called the medical industry or health economy) is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. It includes the generation and commercialization of goods and services lending themselves to maintaining and re-establishing health. The modern healthcare industry is divided into many sectors and depends on interdisciplinary teams of trained professionals and paraprofessionals to meet health needs of individuals and populations.The healthcare industry is one of the world's largest and fastest-growing industries. Consuming over 10 percent of gross domestic product (GDP) of most developed nations, health care can form an enormous part of a country's economy.

Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act (PPACA), often shortened to the Affordable Care Act (ACA) or nicknamed Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the passage of Medicare and Medicaid in 1965.The ACA's major provisions came into force in 2014. By 2016, the uninsured share of the population had roughly halved, with estimates ranging from 20 to 24 million additional people covered during 2016. The increased coverage was due, roughly equally, to an expansion of Medicaid eligibility and to major changes to individual insurance markets. Both involved new spending, funded through a combination of new taxes and cuts to Medicare provider rates and Medicare Advantage. Several Congressional Budget Office reports said that overall these provisions reduced the budget deficit, that repealing the ACA would increase the deficit, and that the law reduced income inequality by taxing primarily the top 1% to fund roughly $600 in benefits on average to families in the bottom 40% of the income distribution. The law also enacted a host of delivery system reforms intended to constrain healthcare costs and improve quality. After the law went into effect, increases in overall healthcare spending slowed, including premiums for employer-based insurance plans.The act largely retains the existing structure of Medicare, Medicaid, and the employer market, but individual markets were radically overhauled around a three-legged scheme. Insurers in these markets are made to accept all applicants and charge the same rates regardless of pre-existing conditions or sex. To combat resultant adverse selection, the act mandates that individuals buy insurance and insurers cover a list of "essential health benefits". However, a repeal of the individual tax mandate, passed as part of the Tax Cuts and Jobs Act of 2017, became effective on January 1, 2019. To help households between 100–400% of the Federal Poverty Line afford these compulsory policies, the law provides insurance premium subsidies. Other individual market changes include health marketplaces and risk adjustment programs.

Since being signed into law in 2010, the PPACA has faced strong political opposition, calls for repeal (overwhelmingly from Republicans) and numerous legal challenges; its enactment is considered to be a catalyst for the Tea Party movement. In National Federation of Independent Business v. Sebelius, the Supreme Court ruled that states could choose not to participate in the ACA's Medicaid expansion, although it upheld the law as a whole. The federal health exchange, HealthCare.gov, faced major technical problems at the beginning of its rollout in 2013. In 2017, a unified Republican government attempted but failed to pass several different partial repeals of the ACA. The law spent several years opposed by a slim plurality of Americans polled, although its provisions were generally more popular than the law as a whole, and the law gained majority support by 2017.

Psychiatric hospital

Psychiatric hospitals, also known as mental hospitals, mental health units, mental asylums or simply asylums, are hospitals or wards specializing in the treatment of serious mental disorders, such as major depressive disorder, schizophrenia and bipolar disorder. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialize only in short term or outpatient therapy for low-risk patients. Others may specialize in the temporary or permanent care of residents who, as a result of a psychological disorder, require routine assistance, treatment, or a specialized and controlled environment. Patients are often admitted on a voluntary basis, but people whom psychiatrists believe may pose a significant danger to themselves or others may be subject to involuntary commitment. Psychiatric hospitals may also be referred to as psychiatric wards or units (or "psych" wards/units) when they are a subunit of a regular hospital.

Modern psychiatric hospitals evolved from, and eventually replaced the older lunatic asylums. The treatment of inmates in early lunatic asylums was sometimes brutal and focused on containment and restraint. With successive waves of reform, and the introduction of effective evidence-based treatments, most modern psychiatric hospitals provide a primary emphasis on treatment, and attempt where possible to help patients control their own lives in the outside world, with the use of a combination of psychiatric drugs and psychotherapy. An exception is in Japan, where many psychiatric hospitals still use physical restraints on patients, tying them to their beds for days or even months at a time.A crisis stabilization unit is in effect an emergency department for psychiatry, frequently dealing with suicidal, violent, or otherwise critical individuals. Open units are psychiatric units that are not as secure as crisis stabilization units. Another type of psychiatric hospital is medium term, which provides care lasting several weeks. In the United Kingdom, both crisis admissions and medium term care are usually provided on acute admissions wards. Juvenile or adolescent wards are sections of psychiatric hospitals or psychiatric wards set aside for children or adolescents with mental illness. Long-term care facilities have the goal of treatment and rehabilitation back into society within a short time-frame (two or three years). Another institution for the mentally ill is a community-based halfway house.

Single-payer healthcare

Single-payer healthcare is a type of universal healthcare financed by taxes that covers the costs of essential healthcare for all residents, with costs covered by a single public system (hence 'single-payer').Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom). "Single-payer" describes the mechanism by which healthcare is paid for by a single public authority, not the type of delivery or for whom physicians work, which may be public, private, or a mix of both.

UnitedHealth Group

UnitedHealth Group Inc. is an American for-profit managed health care company based in Minnetonka, Minnesota. As of 2018, it is ranked #5 on the Fortune 500 rankings of the largest United States corporations by total revenue. UnitedHealth Group offers health care products and insurance services. UnitedHealth Group is the largest healthcare company in the world by revenue with $226.2 billion in 2018. UnitedHealth Group subsidiary companies together serves approximately 115 million individuals in 2016.

Universal health care

Universal healthcare (also called universal health coverage, universal coverage, or universal care) is a health care system that provides health care and financial protection to all residents of a particular country or region. It is organized around providing a specified package of benefits to all members of a society with the end goal of providing financial risk protection, improved access to health services, and improved health outcomes.Universal healthcare does not imply coverage for all people for everything, only that all people have access to healthcare. Some universal healthcare systems are government funded, while others are based on a requirement that all citizens purchase private health insurance. Universal healthcare can be determined by three critical dimensions: who is covered, what services are covered, and how much of the cost is covered. It is described by the World Health Organization as a situation where citizens can access health services without incurring financial hardship. The Director General of WHO describes universal health coverage as the “single most powerful concept that public health has to offer” since it unifies “services and delivers them in a comprehensive and integrated way”. One of the goals with universal healthcare is to create a system of protection which provides equality of opportunity for people to enjoy the highest possible level of health.As part of Sustainable Development Goals, United Nations member states have agreed to work toward worldwide universal health coverage by 2030.

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