Health care

Health care, or healthcare, is the

improvement of health via the prevention,
diagnosis, treatment, amelioration or cure of
disease, illness, injury, and other physical and
mental impairments in people. Health care is
delivered by health professionals and allied
health fields. Medicine, dentistry, pharmacy,
midwifery, nursing, optometry, audiology,
psychology, occupational therapy, physical
therapy, athletic training, and other health
professions all constitute health care. It Global concentrations of health care resources, as
includes work done in providing primary care, depicted by the number of physicians per 10,000
secondary care, and tertiary care, as well as in individuals, by country. Data is sourced from a World
Health Statistics 2010, a WHO report.
public health.

Access to health care may vary across

countries, communities, and individuals,
influenced by social and economic conditions
as well as health 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 healthcare access include
financial limitations (such as insurance
coverage), geographical and logistical barriers
(such as additional transportation costs and the
possibility to take paid time off work to use
such services), sociocultural expectations, and
personal limitations (lack of ability to
communicate with health care providers, poor
health 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).

Health systems are organizations established

to meet the health needs of targeted
populations. According to the World Health
Organization (WHO), a well-functioning
healthcare system requires a financing Graphic of hospital beds per 1000 people globally in 2013,
mechanism, a well-trained and adequately at top;[1] NewYork-Presbyterian Hospital in New York City, a
paid workforce, reliable information on which hub for health care and life sciences,[2] is one of the world's
to base decisions and policies, and well- busiest hospitals, below. Pictured is the Weill-Cornell
maintained health facilities to deliver quality facility (white complex at the center).
medicines and technologies.
An efficient healthcare system can contribute to a significant part of a country's economy, development, and
industrialization. Health care is conventionally regarded as an important determinant in promoting the
general physical and mental health and well-being of people around the world.[5] An example of this was
the worldwide eradication of smallpox in 1980, declared by the WHO, as the first disease in human history
to be eliminated by deliberate healthcare interventions.[6]

Delivery
The delivery of modern health care depends on groups of trained
professionals and paraprofessionals coming together as
interdisciplinary teams.[7] This includes professionals in medicine,
psychology, physiotherapy, nursing, dentistry, midwifery and allied
health, along with many others such as public health practitioners,
community health workers and assistive personnel, who
systematically provide personal and population-based preventive,
curative and rehabilitative care services.
Primary care may be provided in
While the definitions of the various types of health care vary community health centers.
depending on the different cultural, political, organizational, and
disciplinary perspectives, there appears to be some consensus that
primary care constitutes the first element of a continuing health care process and may also include the
provision of secondary and tertiary levels of care.[8] Health care can be defined as either public or private.

Primary care

Primary care refers to the work of health professionals who act as

a first point of consultation for all patients within the health care
system.[8][10] Such a professional would usually be a primary care
physician, such as a general practitioner or family physician.
Another professional would be a licensed independent practitioner
such as a physiotherapist, or a non-physician primary care provider The emergency room is often a
such as a physician assistant or nurse practitioner. Depending on the frontline venue for the delivery of
locality and health system organization, the patient may see another primary medical care.
health care professional first, such as a pharmacist or nurse.
Depending on the nature of the health condition, patients may be
referred for secondary or tertiary care.

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 as Urgent care centers that provide same-day
appointments or services on a walk-in basis.

Primary care involves the widest scope of health care, including all
ages of patients, patients of all socioeconomic and geographic
origins, patients seeking to maintain optimal health, and patients Hospital train "Therapist Matvei
with all types of acute and chronic physical, mental and social Mudrov" in Khabarovsk, Russia[9]
health issues, including multiple 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 and preventive care, health education, and every time they require
an initial consultation about a new health problem. The International 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 and anxiety, back pain, arthritis or thyroid dysfunction. Primary care also
includes many basic maternal and child health care services, such as family planning services and
vaccinations. In the United States, the 2013 National 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 through direct primary care which is a subset of the more familiar concierge
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 include
Foundation Health in Colorado and Qliance in Washington.

In the context of global population aging, with increasing numbers of older adults at greater risk of chronic
non-communicable diseases, rapidly increasing demand for primary care services is expected in both
developed and developing countries.[13][14] The World Health Organization attributes the provision of
essential primary care as an integral component of an inclusive primary health care strategy.[8]

Secondary care

Secondary care includes acute care: necessary treatment for a

short period of time for a brief but serious illness, injury, or other
health condition. This care is often found in a hospital
emergency department. Secondary care also includes skilled
attendance during childbirth, intensive care, and medical
imaging services.[16]

The term "secondary care" is sometimes used synonymously

with "hospital care". However, many secondary care providers, Jackson Memorial Hospital in Miami,
such as psychiatrists, clinical psychologists, occupational the primary teaching hospital of the
therapists, most dental specialties or physiotherapists, do not University of Miami's Leonard M. Miller
necessarily work in hospitals. Some primary care services are School of Medicine and the largest
delivered within hospitals. Depending on the organization and hospital in the United States with 1,547
policies of the national health system, patients may be required beds[15]
to see a primary care provider for a referral before they can
access secondary care.[17][18]

In countries that operate under a mixed market health care system, some physicians 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 group health insurance plans. In other cases,
medical specialists may see patients without a referral, and patients may decide whether self-referral is
preferred.

In other countries patient self-referral to a medical specialist for secondary care is rare as prior referral from
another physician (either a primary care physician or another specialist) is considered necessary, regardless
of whether the funding is from private insurance schemes or national health insurance.
Allied health professionals, such as physical therapists, respiratory therapists, occupational therapists,
speech therapists, and dietitians, also generally work in secondary care, accessed through either patient self-
referral or through physician referral.

Tertiary care

Tertiary care is specialized consultative health care, usually for

inpatients and on referral from a primary or secondary health
professional, in a facility that has personnel and facilities for
advanced medical investigation and treatment, such as a tertiary
referral hospital.[19]

Examples of tertiary care services are cancer management,

neurosurgery, cardiac surgery, plastic surgery, treatment for
severe burns, advanced neonatology services, palliative, and
other complex medical and surgical interventions.[20] National Hospital for Neurology and
Neurosurgery in London, United
Kingdom is a specialist neurological
Quaternary care hospital.

The term quaternary care is sometimes used as an extension of

tertiary care in reference to advanced levels of medicine which are highly specialized and not widely
accessed. Experimental medicine and some types of uncommon diagnostic or surgical procedures are
considered quaternary care. These services are usually only offered in a limited number of regional or
national health care centers.[20][21]

Home and community care

Many types of health care interventions are delivered outside of health facilities. They include many
interventions of public health interest, such as food safety surveillance, distribution of condoms and needle-
exchange programs for the prevention of transmissible diseases.

They also include the services of professionals in residential and community settings in support of self-care,
home care, long-term care, assisted living, treatment for substance use disorders among other types of
health and social care services.

Community rehabilitation services can assist with mobility and independence after the loss of limbs or loss
of function. This can include prostheses, orthotics, or wheelchairs.

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.
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.

Ratings

Health care ratings are ratings or evaluations 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:

health plan quality

hospital quality
of patient experience
physician quality
quality for other health professionals

Related sectors
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.

Health system

A health system, also sometimes referred to as health care system or healthcare system, is the
organization of people, institutions, and resources that deliver health care services to populations in need.

Healthcare industry

The healthcare 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[24] or other allied health professions.

In addition, according to industry and market classifications, such as the Global Industry Classification
Standard and the Industry Classification Benchmark, health care includes many categories of medical
equipment, instruments and services including biotechnology, diagnostic laboratories and substances, drug
manufacturing and delivery.

For example, pharmaceuticals and other medical devices are the leading high technology exports of Europe
and the United States.[25][26] The United States dominates the biopharmaceutical field, accounting for
three-quarters of the world's biotechnology revenues.[25][27]

Health care research

The quantity and quality of many health care interventions are improved through the results of science,
such as advanced through the medical model of health which focuses on the eradication of illness through
diagnosis and effective treatment. Many important advances have been made through health research,
biomedical research and pharmaceutical research, which form the basis for evidence-based medicine and
evidence-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.[28]

Health services research can lead to greater efficiency and equitable delivery of health care interventions, as
advanced through the social model of health and disability, which emphasizes the societal changes that can
be made to make populations healthier.[29] Results from health services research often form the basis of
evidence-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.[30]

Health care financing

See or edit source data.
Total health spending as a fraction of GDP[31]

There are generally five primary methods of funding health care systems:[32]

1. General taxation to the state, county or municipality

2. Social health insurance
3. Voluntary or private health insurance
4. Out-of-pocket payments
5. Donations to health charities

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. In OECD countries for every extra $1000 spent on health care, life expectancy falls by 0.4
years.[33] A similar correlation is seen from the analysis carried out each year by Bloomberg.[34] 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.

In 2011, the health care industry consumed an average of 9.3 percent of the GDP or US$ 3,322 (PPP-
adjusted) per capita across the 34 members of OECD countries. The US (17.7%, or US$ PPP 8,508), the
Netherlands (11.9%, 5,099), France (11.6%, 4,118), Germany (11.3%, 4,495), Canada (11.2%, 5669), and
Switzerland (11%, 5,634) were the top spenders, however life expectancy in total population at birth was
highest in Switzerland (82.8 years), Japan and Italy (82.7), Spain and Iceland (82.4), France (82.2) and
Australia (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 and Mexico.[35][36] (see also international comparisons.)
In the United States, where around 18% of GDP is spent on health care,[34] the Commonwealth Fund
analysis of spend and quality shows a clear correlation between worse quality and higher spending.[37]

Administration and regulation

The management and administration of health care is vital to the delivery of health care services. In
particular, the practice of health professionals and the operation of health care institutions is typically
regulated by national or state/provincial authorities through appropriate regulatory bodies for purposes of
quality assurance.[38] Most countries have credentialing staff in regulatory boards or health departments
who document the certification or licensing of health workers and their work history.[39]

Health information technology

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."[40]

Health information technology components:

Electronic health record (EHR) – An EHR contains a patient's comprehensive medical

history, and may include records from multiple providers.[41]
Electronic Medical Record (EMR) – An EMR contains the standard medical and clinical data
gathered in one's provider's office.[41]
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.[42]
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).
Personal health record (PHR) – A PHR is a patient's medical history that is maintained
privately, for personal use.[43]

See also
Category:Health care by country
Global health
Health equity
Health policy
Healthcare system / Health professionals
Tobacco control laws
Universal health care

By country:

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External links
Media related to Health care at Wikimedia Commons
Travel health travel guide from Wikivoyage

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