Health care (often
healthcare in
American English), is the treatment and management of illness, and
the preservation of
health through services
offered by the
medical,
dental, complementary and
alternative medicine,
pharmaceutical, clinical sciences (
in
vitro diagnostics),
nursing, and
allied health professions.
Health care embraces all the goods and services designed to promote
health, including “preventive,
curative and
palliative interventions, whether directed
to individuals or to populations”. The definition of to recognize,
tough to define,"
Albany Times-Union November 12,
2009.
Before the term
health care became popular,
English-speakers referred to
medicine or to the
health sector and
spoke of the treatment and prevention of
illness and
disease. 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),
health insurance
(reimbursement of health care costs), and the
public health (the collective state and range
of health in a population). The public health is related most to
economic development and wealth distribution, and health insurance
is a business which both provides and restricts reimbursement for
healthcare itself in the event of disease, or in access to of
medical healthcare in individual health-seeking, -promoting or
-maintaining behaviours.
Provision
A
health-care provider is a
person or
organization that provides
services and/or
health-care
personnel to deliver proper health care in a systematic way to
any individual in need of health-care services. A health-care
provider could be a government, the health-care industry, a
health-care equipment company, an institution such as a hospital or
medical laboratory. Health-care
professionals may include
physicians,
dentists, support staff,
nurses,
therapists,
psychologists,
pharmaconomists,
pharmacists,
chiropractors, and
optometrists.
Practicing
health care without a license is generally a serious crime that
could be punished by up to several years in prison.
Health-care industry
The delivery of modern health care depends on an expanding group of
trained
professionals coming together
as an
interdisciplinary
team.
The health-care
industry incorporates
several sectors that are dedicated to providing services and
products dedicated to improving the health of individuals.
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, biotechnology &
life sciences. The particular sectors associated with these groups
are: biotechnology, diagnostic substances, drug delivery, drug
manufacturers, hospitals, medical equipment and instruments,
diagnostic laboratories, nursing homes, providers of health care
plans and home health care.
According to government classifications of Industry, which are
mostly based on the United Nations system, the
International
Standard Industrial Classification, health care generally
consists of Hospital activities, Medical and dental practice
activities, and other human health activities. The last class
consists of all activities for human health not performed by
hospitals or by medical doctors or dentists. This involves
activities of, or under the supervision of, nurses, midwives,
physiotherapists, scientific or diagnostic laboratiories, pathology
clinics, ambulance, nursing home, or other para-medical
practitioners in the field of optometry, hydrotherapy, medical
massage, occupational therapy, speech therapy, chiropody,
homeopathy, chiropractice, acupuncture, etc.
Research
Top
impact factor academic journals in the health care field
include
Health Affairs and
Milbank Quarterly. The
New England Journal
of Medicine,
British Medical Journal, and
the
Journal of the
American Medical Association are more general
journals.
Biomedical research (or
experimental medicine), in general
simply known as
medical research,
is the
basic research,
applied research, or
translational research conducted to
aid the body of knowledge in the field of
medicine. 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, and all other research that
contributes to the development of new treatments. The latter is
termed
preclinical research
if its goal is specifically to elaborate knowledge for the
development of new therapeutic strategies. A new paradigm to
biomedical research is being termed
translational research, which focuses
on iterative feedback loops between the basic and clinical research
domains to accelerate knowledge translation from the bedside to the
bench, and back again.
In terms of pharmaceutical R&D spending,
Europe spends a little less that the United States
(€22.50bn compared to €27.05bn in 2006) and there is less growth in
European R&D spending. Pharmaceuticals and other medical
devices are the leading high technology exports of Europe and the
United States. However, the United States dominates the
biopharmaceutical field, accounting for
the three quarters of the world’s biotechnology revenues and 80% of
world R&D spending in
biotechnology.
World Health Organization
The World Health Organization (WHO) is a specialized
United Nations agency which acts as a
coordinator and researcher for
public
health around the world.
Established on 7 April
1948, and headquartered in Geneva
,
Switzerland, the agency inherited the mandate and resources of its
predecessor, the Health Organization, which had been an agency of
the League of Nations. The
WHO's constitution states that its mission "is the attainment by
all peoples of the highest possible level of health." Its major
task is to combat disease, especially key infectious diseases, and
to promote the general health of the peoples of the world. Examples
of its work include years of fighting
smallpox. In 1979 the WHO declared that the disease
had been eradicated - the first disease in history to be completely
eliminated by deliberate human design. The WHO is nearing success
in developing vaccines against
malaria and
schistosomiasis and aims to
eradicate
polio within the next few years.
The
organization has already endorsed the world's first official
HIV/AIDS Toolkit for Zimbabwe
from
October 3 2006, making
it an international standard.
The WHO is financed by contributions from member states and from
donors. In recent years the WHO's work has involved more
collaboration, currently around 80 such partnerships, with
NGO and the
pharmaceutical industry, as well as
with foundations such as the
Bill and Melinda Gates
Foundation and the
Rockefeller Foundation. Voluntary
contributions to the WHO from national and local governments,
foundations and NGOs, other UN organizations, and the private
sector (including pharmaceutical companies), now exceed that of
assessed contributions (dues) from its 193 member nations.
Economics
Health economics is a branch of
economics concerned with issues related to
scarcity in the allocation of
health and
health care. Broadly, health economists study the functioning of
the health care system and the private and social causes of
health-affecting behaviors such as smoking.
A seminal 1963 article by
Kenneth
Arrow, often credited with giving rise to the health economics
as a discipline, drew conceptual distinctions between health and
other goals.Factors that distinguish health economics from other
areas include extensive
government intervention, intractable
uncertainty in several dimensions,
asymmetric information, and
externalities. Governments tend to
regulate the health care industry heavily and also tend to be the
largest
payer within the market. Uncertainty
is intrinsic to health, both in patient outcomes and financial
concerns. 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; these imbalances lead to market failures
resulting from
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 a cold, or practising safer sex, affects people
other than the decision maker.
The scope of health economics is neatly encapsulated by Alan
William's "plumbing diagram" dividing the discipline into eight
distinct topics:
Consuming just under 10 percent of
gross domestic product of most
developed nations, health care can form an enormous part of a
country's
economy.
In 2001, health care
consumed 8.4 per cent of GDP across the OECD
countries with the United States (13.9%), Switzerland
(10.9%), and Germany
(10.7%)
being the top three.
The United States and Canada account for 48% of world
pharmaceutical sales, while Europe, Japan, and all other nations
account for 30%, 9%, and 13%, respectively. United States accounts
for the three quarters of the world’s biotechnology revenues.
Systems
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 country, state or municipality with a
government 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. The scale, extent, and funding of these private systems
is variable.
A traditional view is that improvements in health result from
advancements in medical science. The
medical model of health focuses on the
eradication of
illness through
diagnosis and effective treatment. In
contrast, 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. It defines
illness from the
point of view of the individual's functioning within their society
rather than by monitoring for changes in
biological or
physiological signs.
The United States currently operates under a
mixed market health care system. Government
sources (federal, state, and local) account for 45% of U.S. health
care expenditures. Private sources account for the remainder of
costs, 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. 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; they have less
short and medium-term incentives than private agents to make
purchases that can generate revenues and avoid bankruptcy. Health
system reform in the United States usually focuses around three
suggested systems, with proposals currently underway to integrate
these systems in various ways to provide a number of health care
options. First is single payer, a term meant to describe a single
agency managing a single system, as found in most modernized
countries as well as some states and municipalities within the
United States. Second are employer or individual insurance
mandates, with which the state of Massachusetts has experimented.
Finally, there is consumer-driven health, in which systems,
consumers, and patients have more control of how they access care.
This is argued to provide a greater incentive to find cost-saving
health care approaches. Critics of consumer-driven health say that
it would benefit the healthy but be insufficient for the
chronically sick, much as the current system operates. Over the
past thirty years, 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; the greater
problems with this approach have been the gradual deregulation of
HMOs resulting in fewer of the promised choices for consumers, and
the steady increase in consumer cost that has marginalized
consumers and burdened states with excessive urgent health care
costs that are avoided with consumers have adequate access to
preventive health care.
A few
states have taken serious steps toward universal health care
coverage, most notably Minnesota
, Massachusetts
and Connecticut
, with recent examples being the Massachusetts 2006
Health Reform Statute and Connecticut's SustiNet plan to provide quality, affordable health
care to state residents.
Criticism
Everyone has the right to a standard of living adequate for the
health and well-being of oneself and one’s family, including food,
clothing, housing, and medical care. The Universal Declaration of
Human Rights, adopted by the United Nations in 1948, Health care
should be human right; however, now healthcare is being sold as
goods, and the poor can not afford to get treated when they are
sick.
Politics
The politics of health care depends largely on which country one is
in. Current concerns in England, for instance, revolve around the
use of
private finance
initiatives to build hospitals which it is argued costs
taxpayers more in the long run. In Germany and France, concerns are
more based on the rising cost of drugs to the governments. In
Brazil, an important political
issue is the breach of
intellectual property rights, or
patents, for the domestic manufacture of
antiretroviral drugs used in the
treatment of HIV/AIDS.
The
South African
government, whose population sets the record for HIV infections,
came under pressure for its refusal to admit there is any
connection with AIDS because of the cost it would have involved. In
the United States 12% to 16% of the citizens are still unable to
afford health insurance. State boards and the Department of Health
regulate inpatient care to reduce the national health care
deficit.To tackle the problems of the perpetually increasing number
of uninsured, and costs associated with the US health care system,
President
Barack Obama says he favors
the creation of a universal health care system. However, New York
Times opinion columnist Paul Krugman said that Obama's plan would
not actually provide universal coverage. (In contrast, Dennis
Kucinich, an early candidate who did not get on the ballot,
supported a single-payer system.) Factcheck.org alleges that
Obama's predicted savings were exaggerated.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.
Health care by country
See also
Notes
- Princeton University. (2007). health
profession. Retrieved June 17, 2007, from Princeton University
- United States Department of Labor. (February 27, 2007). Health
Care Industry Information. Retrieved June 17, 2007, from Employment & Training Administration (ETA) - U.S.
Department of Labor
- Welcome to the United Nations: It's Your World
- Efpia.org, Retrieved June 17, 2009
- Stats from 2007 Europ.Fed.of Pharm.Indust.and Assoc. Retrieved
June 17, 2009, from [1]
- Xinhua - English
- Arrow, K. (1963) Uncertainty and the welfare economics of
medical care. American Economic Review, 53:941-73.
- Phelps, Charles E. (2002) Health Economics 3rd Ed. Addison
Wesley. Boston, MA
- Williams A (1987) "Health economics: the cheerful face of a
dismal science" in Williams A (ed.) Health and Economics,
Macmillan: London
- OECD data
- CMS Annual Statistics, United States Department of Health and Human
Services
- About.com's Pros & Cons of Massachusetts'
Mandatory Health Insurance Program
-
http://www.aarp.org/states/ct/advocacy/articles/in_historic_vote_legislature_overrides_sustinet_veto.html
- Farmer, Paul. 2001. The Major Infectious Diseases in the World
-- To Treat or Not to Treat? NEngl J Med 345 (3):208-210.
- PFI hospital 'costing £20m more' BBC report on
research findings showing that PFI can cost taxpayers more in the
long run
- BBC News: Controversy dogs Aids forum
- The Time Has Come for Universal Health Care | U.S. Senator
Barack Obama
- Clinton, Obama, Insurance, By Paul Krugman, February
4, 2008.
- Obama's Inflated Health Savings
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