Health care

Health care or healthcare is the treatment and prevention of illness. Health care is delivered by professionals in medicine, dentistry, nursing, pharmacy and allied health.

The social and political issues surrounding access to healthcare in the US have led to vigorous public debate and the almost colloquial use of terms such as health care (medical management of illness), health insurance (reimbursement of health care costs), and public health (the collective state and range of health in a population).

Health care industry

The delivery of modern health care depends on an expanding group of trained professionals coming together as an interdisciplinary team.^[1][2]

The health-care industry incorporates several sectors that are dedicated to providing health care services and products. According to industry and market classifications, such as the Global Industry Classification Standard and the Industry Classification Benchmark, the health-care industry includes health care equipment and services as well as pharmaceuticals, biotechnology and 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.^[3]

According to government industry classifications, 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, physicians or dentists. This involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratiories, pathology clinics, home, or other para-medical practitioners in the field of optometry, hydrotherapy, medical massage, music therapy, occupational therapy, speech therapy, chiropody, homeopathy, chiropractics, acupuncture, etc.^[4]

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.^[5][6] Pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States.^[6][7] 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.^[5][6]

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.^[8]

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 NGOs 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.^[9]

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.^[10] Factors that distinguish health economics from other areas include extensive government intervention, intractable uncertainty in several dimensions, asymmetric information, and externalities.^[11] 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 practicing safer sex, affects people other than the decision maker.

The scope of health economics is neatly encapsulated by Alan William's "plumbing diagram"^[12] dividing the discipline into eight distinct topics:

• What influences health? (other than health care)
• What is health and what is its value
• The demand for health care
• The supply of health care
• Micro-economic evaluation at treatment level
• Market equilibrium
• Evaluation at whole system level; and,
• Planning, budgeting and monitoring mechanisms.

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 2008, health care consumed an average of 9.0 percent of GDP across the OECD countries^[13] with the United States (16.0%), France (11.2%), and Switzerland (10.7%)being the top three spenders.

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.^[6] United States accounts for the three quarters of the world’s biotechnology revenues.

Systems

A group of Chilean 'Damas de Rojo', volunteers on their local hospital.

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.^[14]

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.^[15] 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^[16] and Connecticut's SustiNet plan to provide quality, affordable health care to state residents.^[17]

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.^[18] 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^[19] because of the cost it would have involved. In the United States 12% to 16% of the citizens do not have 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.^[20] However, New York Times opinion columnist Paul Krugman said that Obama's plan would not actually provide universal coverage,^[21] and Factcheck.org alleges that Obama's predicted savings were exaggerated.^[22] 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

Health care systems are composed of individuals and organizations that aim to meet the health care needs of target populations. There are a wide variety of health care systems around the world. In some countries, the health care system planning is distributed among market participants, whereas in others planning is made more centrally among governments, trade unions, charities, religious, or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has often been evolutionary rather than revolutionary.

See also

Notes

External links

• HR3200: America's Affordable Health Choices Act of 2009