Health care

This article is about the provision of medical care. For other uses, see Health care (disambiguation).

"Medical Care" redirects here. For the health journal, see Medical Care (journal).

NewYork-Presbyterian Hospital, white complex at centre, one of the world's busiest

Health care or healthcare is the maintenance or improvement of health via the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in human beings. Health care is delivered by health professionals (providers or practitioners) in allied health professions, chiropractic, dentistry, midwifery, nursing, medicine, optometry, pharmacy, psychology, and other health professions. It includes the work done in providing primary care, secondary care, and tertiary care, as well as in public health.

Access to health care varies across countries, groups, and individuals, largely influenced by the capacities and proclivities of each society's population, and to a lesser extent by the health policies in place. Around the world, health care is practiced and delivered by what is sometimes called the health care monopoly. Countries and jurisdictions have different levels of government interference in the personal and population-based health care goals within their societies. Almost always, such services are strictly regulated, have extremely high barriers to entry, and are criticized for being more expensive than necessary.

Health care systems are organizations established to meet the health needs of target populations, though some care almost as much about the benefits and status of their leaders and members. Their exact configuration varies between national and subnational entities. In some countries and jurisdictions, health care planning is distributed among market participants, whereas in others, planning occurs centrally among governments and other coordinating bodies. In all cases, according to the World Health Organization (WHO), a well-functioning health care system requires a robust financing mechanism; a well-trained and adequately-paid workforce; reliable information on which to base decisions and policies; and well maintained health facilities and logistics to deliver quality medicines and technologies.

Health care has been widely advertised as an important determinant in promoting the general physical and mental health and well-being of people around the world. An early 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. However, widespread health care has also led to increasing dysgenic effects, by encouraging a rising mutation load in the human population. This is caused by the increasing number of humans who survive various diseases through increased medical interventions, and through decreased infant mortality. People who would have died in the past due to various genetic maladaptations are now able to survive and pass on their genes to their offspring. Delayed childbearing supported by health care has also helped increase genetic defects, and lowered the birth rate in the West. By indirectly helping to create these problems, health care providers have increased the demand for their services. However, this subject is considered politically incorrect, and can generally not be discussed in the mainstream media.

Health care delivery

See also: Health professionals

Primary care may be provided in community health centres.

Health care services have become economically very important, contributing a significant part of a country's labor productivity. 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 USA (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 USA (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 Mexico and the USA. (see also international comparisons.)

The delivery of modern health care depends on groups of trained professionals and paraprofessionals coming together as interdisciplinary teams. This includes professionals in medicine, psychology, physiotherapy, nursing, dentistry, midwifery and allied health, plus 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, that may also include the provision of secondary and tertiary levels of care. Healthcare can be defined as either public or private.

The emergency room is often a frontline venue for the delivery of primary medical care.

Primary care

Main article: Primary care

See also: Primary health care, Ambulatory care, and Urgent care

Medical train "Therapist Matvei Mudrov" in Khabarovsk, Russia

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. Such a professional would usually be a primary care physician, such as a general practitioner or family physician, a licensed independent practitioner such as a physiotherapist, or a non-physician primary care provider (mid-level provider) such as a physician assistant or nurse practitioner. Depending on the locality, health system organization, and sometimes at the patient's discretion, they may see another health care professional first, such as a pharmacist, a nurse (such as in the United Kingdom), a clinical officer (such as in parts of Africa), or an Ayurvedic or other traditional medicine professional (such as in parts of Asia). Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.

Primary care is often used as the term for the health care services which play a role in the local community. It can be provided in different settings, such as Urgent care centres which provide services to patients same day with appointment or walk-in bases.

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 manner 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 by the reason for the patient visit.

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.

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. The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary health care strategy.

Secondary care

Secondary care is the health care services provided by medical specialists and other health professionals who generally do not have first contact with patients, for example, cardiologists, urologists and dermatologists.

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

The "secondary care" is sometimes used synonymously with "hospital care". However many secondary care providers do not necessarily work in hospitals, such as psychiatrists, clinical psychologists, occupational therapists or physiotherapists (physiotherapists are also primary care providers and a referral is not required to see a physiotherapist), and 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.

For example, in the United States, which operates under a mixed market health care system, some physicians might voluntarily limit their practice to secondary care by requiring patients to see a primary care provider first, or 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 the United Kingdom and Canada, 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

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

See also: Medicine

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.

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.

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 centres. This term is more prevalent in the United Kingdom, but just as applicable in the United States. A quaternary care hospital may have virtually any procedure available, whereas a tertiary care facility may not offer a sub-specialist with that training.

Home and community care

See also: Public health

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 programmes 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 and 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 (mostly in the Western world) are dealing with falling birth rates through the effects of the disintegration of traditional social roles and widespread Third World immigration. This has led to rapidly aging populations, and 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, transporting them to doctor's appointments, and many other activities that are so 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 for home care.

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

Ratings

Main article: Health care ratings

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

• Measures of Hospital quality
• Measures of Health Plan Quality
• Measures of Physician Quality
• Measures of Quality for Other Health Professionals
• Measures of Patient Experience

Related sectors

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

Health system

Main articles: Health system and Health systems by country

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

Health care industry

See also: Health care industry and Health economics

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, or other allied health professions, e.g. in the field of optometry, hydrotherapy, medical massage, yoga therapy, music therapy, occupational therapy, speech therapy, chiropody, homeopathy, chiropractics, acupuncture, etc.

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 as well as biotechnology, diagnostic laboratories and substances, and drug manufacturing and delivery.

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

Health care research

Main articles: Medical research and Nursing research

See also: List of health care journals, List of medical journals, and List of nursing journals

For a topical guide to this subject, see Healthcare science.

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, including biomedical research and pharmaceutical research, which form the basis for evidence-based medicine and evidence-based practice in health care delivery.

For example, in terms of pharmaceutical research and development spending, Europe spends a little less than the United States (€22.50bn compared to €27.05bn in 2006). The United States accounts for 80% of the world's research and development spending in biotechnology.

In addition, the results of 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 population healthier. 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 AI for the development of systems of health assessment that are clinically useful, timely, sensitive to change, culturally sensitive, low burden, low cost, involving for the patient and built into standard procedures.

Health care financing

See also: Health care system, Health policy, and Universal health care

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

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, the financing of health care services features a mix of all five models, but the exact distribution varies across countries and over time within countries. In all countries and jurisdictions, there are many topics in the politics and evidence that can influence the decision of a government, private sector business or other group to adopt a specific health policy regarding the financing structure.

For example, social health insurance is where a nation's entire population is eligible for health care coverage, and this coverage and the services provided are regulated. In almost every jurisdiction with a government-funded health care system, a parallel private, and usually for-profit, system is allowed to operate. This is sometimes referred to as two-tier health care or universal health care.

E. g. in Poland (former communist country) the costs of health services borne by the National Health Fund (financed by all that pay health insurance contributions) in 2012 amounted to 60.8 billion PLN (appr. 20 billion USD). The right to health services in Poland has about 99,9% of population (also registered unemployed persons and their spouses).

Health care administration and regulation

See also: Health professional requisites

The management and administration of health care is another sector 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. Most countries have credentialing staff in regulatory boards or health departments who document the certification or licensing of health workers and their work history.

Health information technology

See also: Health information technology, Health information management, Health informatics, and eHealth

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." Technology is a broad concept that deals with a species' usage and knowledge of tools and crafts, and how it affects a species' ability to control and adapt to its environment. However, a strict definition is elusive; "technology" can refer to material objects of use to humanity, such as machines, hardware or utensils, but can also encompass broader themes, including systems, methods of organization, and techniques. For HIT, technology represents computers and communications attributes that can be networked to build systems for moving health information. Informatics is yet another integral aspect of HIT.

Health information technology can be divided into further components like Electronic Health Record (EHR), Electronic Medical Record (EMR), Personal Health Record (PHR), Practice Management System (PMS), Health Information Exchange (HIE) and many more. There are multiple purposes for the use of HIT within the health care industry. Further, the use of HIT is expected to improve the quality of health care, reduce medical errors, improve the health care service efficiency and reduce health care costs.

See also

• Acronyms in healthcare
• Catholic Church and health care
• Clinical documentation improvement
• Doctor–patient relationship
• Electronic health record
• Healthcare system / Health professionals
• Health center / Clinic / Hospital / Nursing Home
• Health policy
  • Healthy city / Alliance for Healthy Cities
  • Health care reform / Health care reform in the United States / Unnecessary health care
  • Health insurance / Insurance / Right to health /Social health insurance /Subsidies
• List of OECD countries by health care outcome
• Medical classification
  • ATC codes (Anatomical Therapeutic Chemical classification system)
  • Classification of Pharmaco-Therapeutic Referrals (CPR)
  • Diagnostic and Statistical Manual of Mental Disorders (DSM) / List of DSM-IV codes
  • ICD-10 (International Classification of Diseases)
  • International Classification of Primary Care (ICPC-2) / ICPC-2 PLUS
• Medicine / Doctor's visit / Nursing
• Philosophy of healthcare
  • Community health service / Community health centers in the United States
  • Direct primary care (United States)
  • Family medicine / Preventive medicine / Social medicine
  • Social service / Social determinants of health
• Universal health care

External links

• HR3200: America's Affordable Health Choices Act of 2009
• Health Care Policymakers collected news and commentary at The Washington Post
• Defining Primary Care from Institute of Medicine IOM—Primary Care: America's Health in a New Era (1996)
• Primary Care Definitions from American Academy of Family Physicians AAFP
• Definition of Primary Care from American Medical Association AMA
• Defining primary health care Department of Health United Kingdom UK
• What is primary health care? Aboriginal Medical Services Alliance Northern Territory (AMSANT) Australia