A health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities.
An individual health care provider (also known as a health worker) may be a health care professional, an allied health professional, a community health worker, or another person trained and knowledgeable in medicine, nursing or other allied health professions, or public/community health. Institutions (also known as health facilities) include hospitals, clinics, primary care centres and other service delivery points. 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.[1] Together, they form part of an overall health care system.
A hospital is an institution for health care typically providing specialized treatment for inpatient (or overnight) stays. Some hospitals primarily admit patients suffering from a specific disease or affection, or are reserved for the diagnosis and treatment of conditions affecting a specific age group. Others have a mandate that expands beyond offering dominantly curative and rehabilitative care services to include promotional, preventive and educational roles as part of a primary health care approach. Today, hospitals are usually funded by the state, health organizations (for profit or non-profit), by health insurances or by charities and by donations. Historically, however, they were often founded and funded by religious orders or charitable individuals and leaders. Hospitals are nowadays staffed by professionally trained doctors, nurses, paramedical clinicians, etc., whereas in history, this work was usually done by the founding religious orders or by volunteers.
Health care centres, including clinics and ambulatory surgery centers, serve as first point of contact with a health professional and provide outpatient medical, nursing, dental and other types of care services.[2] Health care is a state regulated industry. Out patient facilities are largely unregulated.
Medical nursing homes, including residential treatment centers and geriatric care facilities, are health care institutions which have accommodation facilities and which engage in providing short-term or long-term medical treatment of a general or specialized nature not performed by hospitals to inpatients with any of a wide variety of medical conditions.[3]
Pharmacies and drug stores comprise establishments engaged in retailing prescription or nonprescription drugs and medicines, and other types of medical and orthopaedic goods.[3] Regulated pharmacies may be based in a hospital or clinic or they may be privately operated, and are usually staffed by pharmacists, pharmacy technicians and pharmacy aides.
A medical laboratory or clinical laboratory is a laboratory where tests are done on biological specimens in order to get information about the health of a patient. Such laboratories may be divided into categorical departments such as microbiology, hematology, clinical biochemistry, immunology, serology, histology, cytology, cytogenetics, or virology. In many countries, there are two main types of labs that process the majority of medical specimens. Hospital laboratories are attached to a hospital, and perform tests on these patients. Private or community laboratories receive samples from general practitioners, insurance companies, and other health clinics for analysis.
A biomedical research facility is where basic research or applied research is 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.
Health care practitioners include physicians, dentists, physician assistants, nurses (including advanced practice registered nurses), midwives, pharmacists, dietitians, therapists, psychologists, chiropractors, clinical officers, phlebotomists, physical therapists, respiratory therapists, occupational therapists, audiologists, speech pathologists, optometrists, emergency medical technicians, paramedics, medical laboratory scientists, medical prosthetic technicians, radiographers, social workers, and a wide variety of other human resources trained to provide some type of health care service. They often work in hospitals, health care centres and other service delivery points, but also in academic training, research and administration. Some provide care and treatment services for patients in private homes. Many countries have a large number of community health workers who work outside of formal health care institutions. Managers of health care services, health information technicians, and other assistive personnel and support workers are also considered a vital part of health care teams.[4]
Health care practitioners are commonly grouped into four key fields:
Within each field, practitioners are often classified according to skill level and skill specialization. “Health professionals” are highly skilled workers, in professions that usually require extensive knowledge including university-level study leading to the award of a first degree or higher qualification.[5] This category includes physicians, dentists, nurse practitioners, pharmacists, physiotherapists, optometrists, and others. Allied health professionals, also referred to as "health associate professionals" in the International Standard Classification of Occupations, support implementation of health care, treatment and referral plans usually established by medical, nursing and other health professionals, and usually require formal qualifications to practice their profession. In addition, unlicensed assistive personnel assist with providing health care services as permitted.
Another way to categorize health care practitioners is according to the sub-field in which they practice, such as mental health care, pregnancy and childbirth care, surgical care, rehabilitation care, or public health.
A mental health practitioner is a health worker who offers services for the purpose of improving an individual's mental health or treating mental illness. These include psychiatrists, clinical psychologists, clinical social workers, mental health nurse practitioners, marriage and family therapists, as well as other health professionals and allied health professions. These health care providers often deal with the same illnesses, disorders, conditions, and issues; however their scope of practice often differs. The most significant difference across categories of mental health practitioners is education and training.[6]
A maternal and newborn health practitioner is a health worker who deals with the care of women and their children before, during and after pregnancy and childbirth. These include obstetricians, obstetrical nurses, midwives (including nurse midwives), nurse practitioners, and others. One of the main differences across these professions is the training and authority to provide surgical services and other life-saving interventions.[7] In some developing countries, traditional birth attendants, or traditional midwives, are the primary source of pregnancy and childbirth care for many women and families, although they are not certified or licensed.
A geriatric care practitioner plans and coordinates the care of the elderly and/or disabled to promote their health, improve their quality of life, and maintain their independence for as long as possible. They include geriatricians, geriatric nurses, geriatric care managers, geriatric aides, and others who focus on the health and psychological care needs of older adults.
A surgical practitioner is a health worker who specializes in the planning and delivery of a patient's perioperative care, including during the anaesthetic, surgical and recovery stages. They may include general and specialist surgeons, anesthesiologists, nurse anesthetists, surgical nurses, clinical officers, operating department practitioners, anaesthetic technicians, surgical technologists, and others.
A rehabilitation care practitioner is a health worker who provides care and treatment which aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. These include physiatrists, physiotherapists, orthotists, prosthetists, occupational therapists, recreational therapists, audiologists, speech and language pathologists, respiratory therapists, rehabilitation counsellors, physiotherapy technicians, orthotic technicians, prosthetic technicians, personal care assistants, and others.[8]
A dental care practitioner is a health worker who provides care and treatment to promote and restore oral health. These include dentists and dental surgeons, dental assistants, dental auxiliaries, dental hygienists, dental nurses, dental technicians, dental therapists and related professional titles.
Care and treatment for the foot, ankle, and lower leg may be delivered by podiatrists, pedorthists, foot health practitioners and others.
A public health practitioner focuses on improving health among individuals, families and communities through the prevention and treatment of diseases and injuries, surveillance of cases, and promotion of healthy behaviors. This category includes community and preventive medicine specialists, public health nurses, dietitians, environmental health officers, epidemiologists, health inspectors, and others.
In many societies, practitioners of traditional medicine or alternative medicine are an important primary health care provider, either as integrated within or remaining outside of the formal health care system. These include practitioners in acupuncture, Ayurveda, herbalism, homeopathy, naturopathy, Siddha medicine, traditional Chinese medicine, traditional Korean medicine, Unani, and other medical practices all over the globe.
Many jurisdictions report shortfalls in the number of trained health human resources to meet population health needs and/or service delivery targets, especially in medically underserved areas. For example, in the United States, the 2010 federal budget invested $330 million to increase the number of doctors, nurses, and dentists practicing in areas of the country experiencing shortages of health professionals. The Budget expands loan repayment programs for physicians, nurses, and dentists who agree to practice in medically underserved areas. This funding will enhance the capacity of nursing schools to increase the number of nurses. It will also allow states to increase access to oral health care through dental workforce development grants. The Budget’s new resources will sustain the expansion of the health care workforce funded in the Recovery Act.[9]
In Canada, the 2011 federal budget announced a Canada Student Loan forgiveness programme to encourage and support new family physicians, nurse practitioners and nurses to practise in underserved rural or remote communities of the country, including communities that provide health services to First Nations and Inuit populations.[10]
In Uganda, the Ministry of Health reports that as many as 50% of staffing positions for health workers in rural and underserved areas remain vacant. As of early 2011, the Ministry was conducting research and costing analyses to determine the most appropriate attraction and retention packages for medical officers, nursing officers, pharmacists and laboratory technicians in the country’s rural areas.[11]
At the international level, the World Health Organization estimates a shortage of almost 4.3 million doctors, midwives, nurses and support workers worldwide to meet target coverage levels of essential primary health care interventions.[12] The shortage is reported most severe in 57 of the poorest countries, especially in sub-Saharan Africa.
Some studies suggest that workplace stress is pervasive in the health care industry because of inadequate staffing levels, long work hours, exposure to infectious diseases and hazardous substances leading to illness or death, and in some countries threat of malpractice litigation. According to a report from the United States' National Institute for Occupational Safety and Health, "health care workers have higher rates of substance abuse and suicide than other professions and elevated rates of depression and anxiety linked to job stress." Elevated levels of stress were also linked to high rates of burnout, absenteeism and diagnostic errors, and to reduced rates of patient satisfaction.[13] In Canada, a national report Canada's Health Care Providers also indicated higher rates of absenteeism due to illness or disability among health care workers compared to the rest of the working population, although those working in health care reported similar levels of good health and fewer reports of being injured at work.[14]
Female health care workers may face specific types of workplace-related health conditions and stress. According to the World Health Organization, women predominate in the formal health workforce in many countries, and are prone to musculoskeletal injury (caused by physically demanding job tasks such as lifting and moving patients) and burnout. Female health workers are exposed to hazardous drugs and chemicals in the workplace which may cause adverse reproductive outcomes such as spontaneous abortion and congenital malformations. In some contexts, female health workers are also subject to gender-based violence including from coworkers and patients.[15]
In most jurisdictions, the provision of health care services is regulated by government, and individuals found to be providing medical, nursing or other professional services without the appropriate certification or licence may face sanctions including even criminal charges leading to prison. The number of professions subject to regulation, requisites for individuals to receive professional licensure, and nature of sanctions that can be imposed for failure to comply vary across jurisdictions.
For instance, in the United States, under Michigan state laws, an individual is guilty of a felony if found to be practicing a health profession subject to regulation without a valid license or registration of their own, or exceeding what a limited license or registration allows. The state laws define the scope of practice for medicine, nursing and a number of allied health professions.[16] In Florida, practicing medicine without the appropriate license is a crime classified as a third degree felony,[17] which may give imprisonment up to five years. Practicing a health care profession without a license which results in serious bodily injury classifies as a second degree felony,[17] providing up to 15 years' imprisonment.
In the United Kingdom, healthcare professionals are regulated by the state; the UK Health Professions Council (HPC)[18] protects the 'title' of each profession it regulates. For example, it is illegal for someone to call themself an Occupational Therapist or Radiographer if they are not on the register held by the HPC.
A health care system is the organization by which health care is provided. The exact configuration of health systems varies from country to country, but in all cases in order to function a system requires institutions and facilities, health care practitioners and professionals, and a financing mechanism.[19] The system may be managed and/or funded by governments, or operated completely or partially by private market-based institutions. The mechanisms governing health care in a given jurisdiction depend on the nature of the health policies in place.
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