Talk:Health care

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Contents 1 Comments 2 Reorganisation of sections 3 Definition 4 Holistic Neologism 5 History Of 6 Merge content from Health care delivery 7 Healthcare policy 8 Health( )care 9 jaundice 10 Page Merge 11 A separate merger, I think? 12 Merging 13 Merger 14 Health Care Quality paragraph 15 Fair use rationale for Image:Medicare-brand.png 16 Reorganise the sections 17 OECD data 18 Three sectors of health care

[edit] Comments

Why does "Health Service Journal" redirect to this page?? —Preceding unsigned comment added by 128.122.242.66 (talk) 20:05, 17 October 2007 (UTC)

This is far to United-States centric. They mentions, of say the NHS (After all the 4th largest employer on earth) are only passing. Surely you Americans out there can find the heart to allow comment on the NHS more than you do!

Why was the link to HealingReform.org removed? It is the place where I get news about Health Care on the internet (besides Wikipedia). It gives a broad perspective from both sides of the debate.

The article assumes nationalized healthcare is good. This is in dispute so it's wrong for a wikipedia entry to have such bias.

[edit] Reorganisation of sections

I removed the section on healthcare by country as there is now category:healthcare by nationality. So, rather than adding a long list of nations here, I have added a link to the new category. I have rearranged the paragraphs slightly to make the preview shorter and grouped the information on the healthcare industry into one place. --Vincej 13:32, 24 July 2005 (UTC)

[edit] Definition

Regarding: "I agree with your rewording of the first sentence, except I have readded the link to allied health as not everyone will know what this is. I think that 'social' should be added to the definition (I have not done so, as yet) which is then consistent then with WHO definition of health. [1] What do you think?" I am not a fan of the WHO definition of health for reason described in Health, however, I'm not against the idea of including "social" in the definition: "Health care or healthcare is the prevention, treatment, and management of illness and the preservation of mental, physical, and social well-being through the services offered by the medical and allied health professions." To what specifically would "social well-being" refer, though? Edwardian 19:42, 9 August 2005 (UTC)

Social well-being is being in a comfortable social condition, enough resources, somewhere to live, occupied etc. Most models of health state that social conditions are an essential component of health. However, it could be contested that although social conditions are a contributor to health they are not part of health care, per se. After all, the phrase is often split into health and social care indicating that they are separate entities. Nevertheless, the brief section on the social model of healthcare, that I contributed, hopefully gives credence to seeing health from a social perspective.(If interested, this debate is further articulated here [2])I am happy to either canvas opinon on the topic prior to adding 'social' or to go ahead and allow other Wikipedians to edit as they see fit. --Vincej 10:30, 10 August 2005 (UTC)

I accept your definition of "social well-being", however, I am not certain that social-well being services (i.e. "providing for enough resources, somewhere to live" etc.) are those which medical and allied health professionals offer. Social well-being certainly affects or is affected by health or healthcare (and perhaps that is enough to include "social" in the definition), but I'm concerned that writing the definition that way might necessitate that social workers and homeless shelter volunteers are included as "allied health professionals". Edwardian 16:07, 10 August 2005 (UTC)

Agreed. Let's leave it as it is for now with social well-being as one of the determinants of health rather than a product of healthcare and see what others think. --Vincej 09:10, 11 August 2005 (UTC)

[edit] Holistic Neologism

Certainly, I can accept that health care is a neologism butI find the term "holistic neologism" objectionable. Not only is it POV but its meaning is extremely murky - is a holist neologism one that arises in a holistic, organic fashion? What is meant is something like "new age neologism" but idea that the term "health care" originated this way needs a bit of support.

The funny is that only references to the phrase "holistic neologism" on google point back to mirrors of this article but were more than six hundred when I checked.

Hans Joseph Solbrig 19:55, 20 September 2005 (UTC)

[edit] History Of

This page is badly in need of a "History Of" section... -Elindstr 00:44, 2 June 2006 (UTC)

[edit] Merge content from Health care delivery

I propose that the entire content of the Health care delivery be put in this section. It seems to be more of a section than a page in itself --Vince 08:30, 9 June 2006 (UTC)

I would support that merge. -AED 09:58, 24 July 2006 (UTC)

Merging is fine, but rename it as medical care. The system really has little or no promotion of health. A health care article would discuss diet, exercise, abstinence from harmful chemicals, practical safety, and other such items. We go to the medical system to treat disease and injuries, not to improve health. Dwayne Stevenson, 5 October 2006

Although on one level I can sympathise with your comment, health care encompasses a number of different professions, not all of whom are alligned to medicine. I would encourage you to add some content to the article about health promotion as I think part of delivery of healthcare is health promotion, remembering to keep it NPOV of course --Vince 10:08, 7 October 2006 (UTC)

[edit] Healthcare policy

I'm requesting that Healthcare policy be merged into this article because neither one is particularly long at this point and I honestly don't see how they're all that different in the first place. --Jemiller226 07:09, 28 November 2006 (UTC)

[edit] Health( )care

Why is the title of the article (and other healthcare-related articles) written as two distinct words, and yet all references within the article as a single word "healthcare"? I see that the first paragraph states both can be used, but is there not a wiki-standard? Or at least agreement between page name and the article itself. Personally I am more familiar with the single word, but I would not object to the double if it became the standard. MickO'Bants 18:57, 28 November 2006 (UTC)

[edit] jaundice

what are the ristriction —The preceding unsigned comment was added by 203.200.95.130 (talk) 15:33, 6 January 2007 (UTC).

[edit] Page Merge

I suggest Health plan be merged with this article. If you read both articles, you can see that "Health plan" is but just another name for "Health care," and both entries hold virtually the same information. --I Are Scientists 21:26, 12 April 2007 (UTC)

• Against - these are two quite distinct things: health care concerns the provision of various services designed to improve the health of a population, whereas health plan is an insurance based method of paying for individual treatment. As you will see, if you look at Health insurance, there is quite a lot to say about this subject which is not suitable for the article Health care. If you wanted to propose that Health plan be merged with Health insurance, I would agree instantly. Abtract 09:51, 17 April 2007 (UTC)

• Against and I've changed the merger proposal on Health plan to point to Health insurance. I'll copy the discussion so far into Talk:Health insurance. Canuckle 19:04, 20 July 2007 (UTC)

[edit] A separate merger, I think?

[edit] Merger

I oppose merger. I don't understand your reason for merging. Health care, and universal health care, are both enormously complicated topics. If universal health care were merged into health care, it would have to be condensed to a paragraph, and it would be impossible for people pro and con to present their views in enough detail to satisfy them. Furthermore, universal health care is an important policy debate.

It seems to me that merging would violate NPOV, because it would diminish the importance of universal health care. People who don't care about universal health care want to get rid of the article.

There is definitely no consensus for merging. Many of us oppose it. You should wait for a consensus. Nbauman 00:12, 16 July 2007 (UTC)

[edit] Health Care Quality paragraph

I deleted the paragraph which referred to the CMA and the Ontario College of Physicians and Surgeons in reference to quality assessment of health care delivery. Firstly, it clearly appeared to be trying to make a point about the CMA/College, and at the very least is very/too specific to a Canadian context. Secondly, it had several errors, which I outlined in the Edit page -- namely, that the Ontario College does not regulate all Canadian doctors, but those in Ontario only, of course. And CMA, while as association of members who are mainly physicians, etc..., is not technically a (labour) union. Lastly, it references an article in the Toronto Star, but the link does not jump to any such article. 128.86.154.16 14:29, 28 October 2007 (UTC)

[edit] Fair use rationale for Image:Medicare-brand.png

Image:Medicare-brand.png is being used on this article. I notice the image page specifies that the image is being used under fair use but there is no explanation or rationale as to why its use in this Wikipedia article constitutes fair use. In addition to the boilerplate fair use template, you must also write out on the image description page a specific explanation or rationale for why using this image in each article is consistent with fair use.

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If there is other fair use media, consider checking that you have specified the fair use rationale on the other images used on this page. Note that any fair use images uploaded after 4 May, 2006, and lacking such an explanation will be deleted one week after they have been uploaded, as described on criteria for speedy deletion. If you have any questions please ask them at the Media copyright questions page. Thank you.

BetacommandBot 01:43, 7 November 2007 (UTC)

[edit] Reorganise the sections

The last section on healthcare providers should come much earlier in the article.Avman M2 (talk) 11:41, 24 March 2008 (UTC)

[edit] OECD data

Gregalton - I don't understand what the problem is here. The moral hazard problem for insurance companies stands as written, including the exacerbation when out of pocket costs are less than the true cost. It is a very clear statement by OECD that the fraction covered by insurance in the US is largest, and that out of pocket costs are the lowest. The OECD is certainly a reliable source, and the data are not ambiguous. You see the point I am trying to make, please help me to make it. PAR (talk) 21:30, 21 April 2008 (UTC)

There are several points here: first, you need a source for the claim that the moral hazard problem is why the costs are higher - even if it seems straightforward to you, it is not apparent to me. You are claiming is that the issue is % of costs paid by private insurance, while I see no reason to distinguish between public/private insurance as far as moral hazard goes.

Out of pocket costs are not in fact the lowest - even in the limited table in the article, France and Germany are lower, and UK/Canada are close - but the per capita expenditure is much lower in each of these cases. In other words, it is not clear to me that there is a relationship at all, nor that the relationship is simple or direct. (Rhetorical: if I were to plot out-of-pocket costs vs per capita costs - straight, log, or PPP corrected/log - would there be a relationship?).

Second, the data are quite ambiguous: there are a number of other factors that could affect costs (including, for example, asymmetrical information problems). In statistical terms, even if there is a relationship (which is not demonstrated), you have not demonstrated that the moral hazard problem is the primary driver.

I could quite easily make the same argument that the issue is private insurance (which might be expected to be a driver of information assymetry problems), and this would seem to fit the (limited) data much better. Even if I were to make that argument, though, I would need to provide a source, or it would be original research. (There is an exception made for statements that are completely obvious, but of course, if someone challenges it, it is probably not completely obvious).

Finally, the literature on moral hazard in health insurance that I have seen generally says this is a minor factor and controllable using the usual insurance tools like co-payments. The main point most have made on this is - to over-simplify considerably - the pain, suffering, inconvenience and not inconsiderable risks of medical procedures is sufficient deterrent for most insurance beneficiaries to dissuade them from excessive over-use of health benefits (sometimes stated as "no-one has bypass surgery for fun"). The counter-argument is sometimes made that e.g. visits to doctors are over-consumed, but a) in many medical systems it is the high-cost procedures that dominate the cost equation, and b) many people under-consume preventative medicine if up-front costs are high, which can raise costs in the long-term.

All of this to say that what you have attributed as a straightforward cause-effect relationship is not established as a relationship, and not established as the cause of high U.S. costs.--Gregalton (talk) 08:27, 22 April 2008 (UTC)

I agree with you that the moral hazard problem does not depend on whether the insurance is public or private, and the statement on moral hazard should not imply otherwise. The point I am trying to make is that out of pocket costs in the US are *among* the smallest, even though the fraction paid by the government is low. The low government contribution might give the false impression that the remainder was out of pocket from the insured. As to your rhetorical question, the relationship might not jump out, unless it was regressed with other factors as well, which is to say, I don't know if there would be a relationship in a simple plot, and if there wasn't, it certainly wouldn't prove a lack of correlation. Also, I don't mean to imply that moral hazard is THE reason why costs are higher, or that it is the "primary driver", only that it is a contributing factor, as is adverse selection, and a number of other effects, which should be listed here. If you have references that say it is a minor factor, by all means lets include those references. I have some that say otherwise, lets include those too. I think it would be good if this section could quickly but succinctly summarize the various points of contention on the economics of health care.

if you have a source that claims that, then use that source; that is what I said in the first place. I'm saying the OECD data isn't sufficient for the causal claim you are making.Gregalton (talk) 21:05, 23 April 2008 (UTC)

Just because I'm a geek, I plotted the data for North American and Western Europe. Short form: no clear relationship. If all of the countries marked as Europe (i.e. former Soviet Union/Eastern Europe), you might find one - essentially that countries with very low expenditures on health care have highest proportion of out-of-pocket expenses; unclear relationship after PPP expenditures on health care exceed about $1000 or so. I could very plausibly make the argument that causality runs the opposite way, that in poor/poorly governed countries there are few govt support programs and/or private insurance products (for example, under-development of financial sector may be one factor affecting these figures). Of course, this is original research, so I'm still just asking for a source.--Gregalton (talk) 12:03, 24 April 2008 (UTC)

Im not sure what source you are asking for. The source I have (Healthy Competition - Cato) claims that moral hazard is a contributing factor and that lower out of pocket expenses exacerbate the problem. But it makes no further claims, so I agree with you, the article should make no further claims either. I reread what I wrote originally, and I see why you objected, it seemed that I was claiming that the high private insurance was a contributing factor. I should have made clear that the high private insurance explained the low out-of-pocket number, which was the actual contributing cause. I was concerned that the low government contribution for the US would be interpreted as a high out-of-pocket expense. Regarding your plot, Im not sure what you plotted, was it out-of-pocket per person versus expenditure per person? PAR (talk) 18:23, 24 April 2008 (UTC)

I meant a source that does more than (like Cato tends to do) claim that it is a factor, rather than attempting to determine whether this is an actual cause.

I plotted the out of pocket as % of expenditure vs expenditure per person. U.S. was unremarkable except in expense, i.e. no clear relationship.--Gregalton (talk) 18:57, 24 April 2008 (UTC)

Well actually, Cato claims it is a large factor, and ignores adverse selection entirely. They are biased towards the free market, but on the plus side, they lay out the free market argument very well. I've never found a source that wasn't biased in some way. As for the plot, just because no clear correlation shows up, doesn't mean there isn't one. It may be obscured by other factors. About the best you can say is that if a correlation does show up, you have something. If it doesn't, then you may or may not have something. Also, as the old saying goes, correlation does not imply causality. PAR (talk) 22:46, 24 April 2008 (UTC)

For Cato to claim moral hazard is a large factor without further analysis and to ignore adverse selection is absurdly disingenuous - I'd say mendaciously so. Adverse selection in health insurance markets is a Big Deal.

For the plot, I agree entirely (and believe I said that earlier...), it does not show no causality. It does, however, show that there is considerable ambiguity about whether there is a relationship at all, i.e. the claim is not self-evident and would need sources for anything beyond the theoretical argument.--Gregalton (talk) 06:01, 25 April 2008 (UTC)

Do you have a good reference concerning the workings of adverse selection? As I understand it, it results from information assymetry - the insured knows more about their health than the insurer. But the same might be said of credit markets, and they seem to function ok. A person seeking credit knows more about their ability to pay than the credit provider, but the credit provider has access to credit history and all other sorts of information. It seems to me that if a similar situation held for medical information, adverse selection would not be as severe. PAR (talk) 09:18, 26 April 2008 (UTC)

I'll try to find the sources I have on adverse selection (will take a while - limited time right now) - which yes, is a type of information asymmetry problem. It is somewhat akin to the Used Car (Lemon) problem, where (due to risks) only lemons are likely to be for sale. The issue is not entirely due to individuals knowing their health history, but that insurers will tend to set insurance prices to price out "risky" clients, which encourages more low-risk clients, which makes insurers set prices higher, etc. Several issues are (arguably) quite different from credit markets: the clients may have very incorrect information (perceptions) of their own risk (and consequences of same), and information about health risks may be much better hidden/expensive to acquire (making the primary task of insurance company to spend money on selection, raising transaction costs and one could argue means - perversely - that only those who are least likely to need insurance will be able to afford it). There is also a free rider problem that will tend to make things even worse where adverse selection exists - in this case, not that the insured/uninsureds behaviour changes (as in typical moral hazard) but where there is some reasonable likelihood that catastrophic risks (read: emergency health care) will be picked up by someone else (the govt, for example); if insurance is expensive (due to adverse selection), there is greater incentive to "free ride" due to risks - and for those with constrained income, no alternative.

I'm thinking about your analogy to credit markets...this definitely comes up when risk and rates are high; I think the answer there is two-fold, that lenders' information is actually pretty good (in comparison), and that their risk is limited to the amount they lend. For insurers, the amount at risk in each transaction is ex ante unknowable (hence the contrast that banks never know the exact value of their assets, but know their liabilities; insurers know their assets, but never know the value of their liabilities - this is a simplification but illustrative).--Gregalton (talk) 19:28, 26 April 2008 (UTC)

[edit] Three sectors of health care

I have not found any information about three sectors of health care: popular, folk and professional (Kleinman, A. Patietns and Healers in the Context of Culture, Berkeley: California University Press, 1980). This article is only concerned with professional sector. Since this division is not the only point of view, it is not necessary to comletely reorganize the article, but I think it should be at least mentioned. Jaroslav Pavliš (talk) 14:53, 8 May 2008 (UTC)