Global concentrations of health care resources, as depicted by the number of physicians per 10,000 individuals, by country. Data is sourced from a World Health Statistics 2010, aWHO report.[needs update]
Access to health care may vary across countries, communities, and individuals, influenced by social and economic conditions andhealth policies. Providing health care services means "the timely use of personal health services to achieve the best possible health outcomes".[3] Factors to consider in terms of health care access include financial limitations (such as insurance coverage),geographical andlogistical barriers (such as additional transportation costs and the ability to take paid time off work to use such services),sociocultural expectations, and personal limitations (lack of ability to communicate with health care providers, poorhealth literacy, low income).[4] Limitations to health care services affect negatively the use of medical services, the efficacy of treatments, and overall outcome (well-being, mortality rates).
Health systems are theorganizations established to meet the health needs of targeted populations. According to theWorld Health Organization (WHO), a well-functioning health care system requires a financing mechanism, a well-trained and adequately paidworkforce, reliable information on which to base decisions andpolicies, and well-maintainedhealth facilities to deliver quality medicines and technologies.
An efficient health care system can contribute to a significant part of a country'seconomy, development, andindustrialization. Health care is an important determinant in promoting the generalphysical andmental health andwell-being of people around the world.[5] An example of this was the worldwideeradication ofsmallpox in 1980, declared by the WHO, as the firstdisease in human history to be eliminated by deliberate health care interventions.[6]
While the definitions of the various types of health care vary based on the differentcultural, political, organizational, and disciplinary perspectives, there is general consensus that primary care constitutes the first element of a continuous health care process and may also include the provision of secondary and tertiary levels of care.[8] Health care can be defined as eitherpublic orprivate.[citation needed]
Theemergency room is often a frontline venue for the delivery of primary medical care.
Primary care refers to the work ofhealth professionals who act as a first point of consultation for allpatients within thehealth care system. The primary care model supports first-contact, accessible, continuous, comprehensive and coordinated person-focused care.[10] Such a professional would usually be aprimary care physician, such as ageneral practitioner orfamily physician. Another professional would be a licensed independent practitioner such as aphysiotherapist, or a non-physician primary care provider such as aphysician assistant ornurse practitioner. Depending on the locality and health system organization, the patient may see another health care professional first, such as apharmacist ornurse. Depending on the nature of the health condition,patients may bereferred for secondary or tertiary care.[citation needed]
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 asUrgent care centers that provide same-day appointments or services on a walk-in basis.[citation needed]
Primary care involves the widest scope of health care, including all ages of patients, patients of allsocioeconomic and geographic origins, patients seeking to maintain optimalhealth, and patients with all types of acute and chronic physical,mental and social health issues, includingmultiple 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 andpreventive care,health education, and every time they require an initial consultation about a new health problem. TheInternational 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.[11]
Common chronic illnesses usually treated in primary care may include, for example,hypertension,diabetes,asthma,COPD,depression andanxiety,back pain,arthritis orthyroid dysfunction. Primary care also includes many basicmaternal and child health care services, such asfamily planning services andvaccinations. In the United States, the 2013National 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.[12]
In the United States, primary care physicians have begun to deliver primary care outside of the managed care (insurance-billing) system throughdirect primary care which is a subset of the more familiarconcierge 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 includeFoundation Health in Colorado andQliance in Washington.[citation needed]
In the context of globalpopulation aging, with increasing numbers of older adults at greater risk of chronicnon-communicable diseases, rapidly increasing demand for primary care services is expected in both developed and developing countries.[13][14] TheWorld Health Organization attributes the provision of essential primary care as an integral component of an inclusiveprimary health care strategy.[8]
The term "secondary care" is sometimes used synonymously with "hospital care". However, many secondary care providers, such aspsychiatrists,clinical psychologists,occupational therapists, mostdental specialties orphysiotherapists, 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 areferral before they can access secondary care.[17][18]
In countries that operate under amixed market health care system, somephysicians 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 grouphealth insurance plans. In other cases,medical specialists may see patients without a referral, and patients may decide whether self-referral is preferred.[citation needed]
Tertiary care is specialized consultative health care, usually forinpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advancedmedical investigation and treatment, such as atertiary referral hospital.[19]
The termquaternary care is sometimes used as an extension of tertiary care in reference to advanced levels of medicine which are highlyspecialized and not widely accessed.Experimental medicine and some types of uncommondiagnostic orsurgical procedures are considered quaternary care. These services are usually only offered in a limited number of regional or national health care centers.[20][21]
Many types of health care interventions are delivered outside of health facilities. They include many interventions ofpublic health interest, such asfood safety surveillance, distribution ofcondoms andneedle-exchange programs for the prevention of transmissible diseases.[citation needed]
Many countries 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.[22]
Because statistics show that over 80 million Americans have taken time off of their primary employment to care for a loved one,[23] many countries have begun offering programs such as the Consumer Directed Personal Assistant Program to allow family members to take care of their loved ones without giving up their entire income.[citation needed]
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 a positive self-image.[24]
Health care ratings are ratings orevaluations 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:[citation needed]
Access to health care may vary across countries, communities, and individuals, influenced by social and economic conditions as well ashealth policies. Providing health care services means "the timely use of personal health services to achieve the best possible health outcomes".[3] Factors to consider in terms of health care access include financial limitations (such as insurance coverage),geographical andlogistical barriers (such as additional transportation costs and the ability to take paid time off work to use such services),sociocultural expectations, and personal limitations (lack of ability to communicate with health care providers, poorhealth literacy, low income).[4] Limitations to health care services affects negatively the use of medical services, the efficacy of treatments, and overall outcome (well-being, mortality rates).[citation needed]
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.
Ahealth system, also sometimes referred to ashealth care system orhealthcare system, is the organization of people, institutions, and resources that deliver health care services to populations in need.[citation needed]
Thehealthcare 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[25] or otherallied health professions.
For example, pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States.[26][27] The United States dominates thebiopharmaceutical field, accounting for three-quarters of the world's biotechnology revenues.[26][28]
The quantity and quality of many health care interventions are improved through the results of science, such as advanced through themedical model of health which focuses on the eradication ofillness throughdiagnosis and effective treatment. Many important advances have been made through health research,biomedical research andpharmaceutical research, which form the basis forevidence-based medicine andevidence-based practice in health care delivery. Health care research frequently engages directly with patients, and as such issues for whom to engage and how to engage with them become important to consider when seeking to actively include them in studies. While single best practice does not exist, the results of a systematic review on patient engagement suggest that research methods for patient selection need to account for both patient availability and willingness to engage.[29]
Health services research can lead to greater efficiency and equitable delivery of health care interventions, as advanced through thesocial model of health and disability, which emphasizes the societal changes that can be made to make populations healthier.[30] Results from health services research often form the basis ofevidence-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.[31]
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 health care. For the purposes of comparison, this is often expressed as the percentage of GDP spent on health care. InOECD countries for every extra $1000 spent on health care, life expectancy falls by 0.4 years.[34] A similar correlation is seen from the analysis carried out each year by Bloomberg.[35] Clearly this kind of analysis is flawed in that life expectancy is only one measure of a health system's performance, but equally, the notion that more funding is better is not supported.[citation needed]
In the United States, the healthcare industry accounts for 18% of gross domestic product in 2020 and is one of the largest and most complex parts of the U.S. economy.[36] In 2011, thehealth care industry consumed an average of 9.3 percent of theGDP orUS$ 3,322 (PPP-adjusted) per capita across the 34 members ofOECD countries. The US (17.7%, or US$ PPP 8,508), theNetherlands (11.9%, 5,099),France (11.6%, 4,118),Germany (11.3%, 4,495),Canada (11.2%, 5669), andSwitzerland (11%, 5,634) were the top spenders, howeverlife expectancy in total population at birth was highest in Switzerland (82.8 years),Japan andItaly (82.7),Spain andIceland (82.4), France (82.2) andAustralia (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 andMexico.[37][38] (see alsointernational comparisons.)
In theUnited States, where around 18% of GDP is spent on health care,[35] theCommonwealth Fund analysis of spend and quality shows a clear correlation between worse quality and higher spending.[39]
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."[43]
Health information technology components:
Electronic health record (EHR) – An EHR contains a patient's comprehensive medical history, and may include records from multiple providers.[44]
Electronic Medical Record (EMR) – An EMR contains the standard medical and clinical data gathered in one's provider's office.[44]
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.[45]
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).[citation needed]
Personal health record (PHR) – A PHR is a patient's medical history that is maintained privately, for personal use.[46]
^Christensen L, Grönvall E (2011). "ECSCW 2011: Proceedings of the 12th European Conference on Computer Supported Cooperative Work, 24–28 September 2011, Aarhus Denmark". In S. Bødker, N. O. Bouvin, W. Letters, V. Wulf, L. Ciolfi (eds.).ECSCW 2011: Proceedings of the 12th European Conference on Computer Supported Cooperative Work, 24–28 September 2011, Aarhus Denmark. London: Springer. pp. 61–80.doi:10.1007/978-0-85729-913-0_4.ISBN978-0-85729-912-3.
^Bond J., Bond S. (1994).Sociology and Health Care. Churchill Livingstone.ISBN978-0-443-04059-7.
^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. Vol. 39. pp. 10533–10543.doi:10.1016/j.eswa.2012.02.120.
^abcdOECD Data.Health resources - Health spendingArchived 12 April 2020 at theWayback Machine.doi:10.1787/8643de7e-en. 2 bar charts: For both: From bottom menus: Countries menu > choose OECD. Check box for "latest data available". Perspectives menu > Check box to "compare variables". Then check the boxes for government/compulsory, voluntary, and total. Click top tab for chart (bar chart). For GDP chart choose "% of GDP" from bottom menu. For per capita chart choose "US dollars/per capita". Click fullscreen button above chart. Click "print screen" key. Click top tab for table, to see data.
^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.
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