Health Care

Health care, health-care, or healthcare is the maintenance or improvement of health via the prevention, diagnosis, treatment, recovery, or cure of disease, illness, injury, and other physical and mental impairments in people. It includes work done in providing primary care, secondary care, tertiary care, and if necessary quaternary care, as well as in public health. Dentistry, pharmacy, midwifery, nursing, medicine, optometry, audiology, psychology, occupational therapy, physical therapy, athletic training, and other health professions are all part of health care.

Health care is a vital aspect of human society. Through the health care system, health professionals in all fields are trained to serve the population as a whole while tending to each patient on an individual basis to achieve the best possible health outcome.

Delivery

The delivery of modern health care depends on groups of trained professionals and paraprofessionals coming together as interdisciplinary teams. 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. Health care can be provided as either a public or a private service.

While the definitions of the various types of health care vary depending on the different cultural, political, organizational, and disciplinary perspectives, primary care constitutes the first element of a continuing health care process which may also include the provision of secondary and tertiary levels of care.

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, and can cover the majority of a person’s health needs throughout their life. It addresses the broader determinants of health including all aspects of physical, mental, and social health, from the perspectives of prevention, treatment, rehabilitation, and palliative care.^[1] The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary health care strategy.

Primary care is usually offered by primary care physicians, such as general practitioners or family physicians. Other professionals offering primary care include licensed independent practitioners such as physiotherapists, or non-physician primary care providers such as physician assistants or nurse practitioners. Depending on the local health system organization the patient may see another 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 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 with all types of acute and chronic physical, mental and social 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. However, primary care can also be provided in different settings, such as Urgent care centers providing same day appointments or services on a walk-in basis.

Common chronic illnesses usually treated in primary care may include: 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 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.^[2][3]

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. Other secondary care providers, such as [[psychiatrists]], clinical psychologists, occupational therapists, most dental specialties and physiotherapists, do not necessarily work in hospitals.

Depending on the organization and policies of the national health system, patients may be required to see a primary care provider for a referral before they can access secondary care. This restriction may be imposed under the terms of the payment agreements in private or group health insurance plans.

In countries which 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. In other cases, medical specialists may see patients without a referral, and patients may decide whether self-referral is preferred. 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.

Examples of tertiary care services include cancer management, neurosurgery, cardiac surgery, plastic surgery, treatment for severe burns, advanced neonatology services, palliative, and other complex medical and surgical interventions.^[4]

Quaternary care

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.^[4] These services are usually only offered in a limited number of regional or national health care centers.

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 loss of limbs or loss of function. This can include prosthesis, 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 a section of health care geared to providing seniors with help in day-to-day activities at home, including household maintenance, personal care, and transportation to and from doctor's appointments.^[5]

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:

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

Health professional requisites

Health professional requisites refer to the regulations used by countries to control the quality of health workers practicing in their jurisdictions and to control the size of the health labor market. They include licensure, certification, and proof of minimum training for regulated health professions.

The management and administration of health care is vital to the delivery of health care services. In particular, 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.^[6]

In the health care system, a health professional who offers medical, nursing, or other types of health care services is required to meet specific requisites put into effect by laws governing health care practices. The number of professions subject to regulation, the requisites for an individual to receive professional licensure or certification, the scope of practice that is permitted for the individual to perform, and the nature of sanctions that can be imposed for failure to comply vary across jurisdictions. The processes for professional certification and licensure vary across professions and countries.

Most countries have credentialing staff in regulatory boards or health departments who document the certification or licensing of health workers and their work history.^[7] Certification to practice a profession usually does not need to be renewed, while a license usually needs to be periodically renewed based on certain criteria such as passing a renewal exam, demonstrating continuing learning, being employed in the field or simply paying a fee. Practicing health care without the appropriate license is generally a crime.

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. Providing health care services means "the timely use of personal health services to achieve the best possible health outcomes."^[8]

Access to health care may vary across countries, communities, and individuals, influenced by social and economic conditions as well as health policies. Limitations to health care services affects negatively the use of medical services, the efficacy of treatments, and overall outcome (well-being, mortality rates). Factors to consider in terms of healthcare access include financial limitations (such as insurance coverage), geographic barriers (such as additional transportation costs, possibility to take paid time off of work to use such services), and personal limitations (lack of ability to communicate with healthcare providers, poor health literacy, low income).^[9]

Health system

A Health care system is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations. A well-functioning health care system requires a financing mechanism, a well-trained and adequately paid workforce, reliable information on which to base decisions and policies, and well maintained health facilities to deliver quality medicines and technologies.^[10]

There is a wide variety of health systems around the world. As with other social institutional structures, health systems are likely to reflect the history, culture, and economics of the states in which they evolve. Nations design and develop health systems in accordance with their needs and resources, although common elements in virtually all health systems are primary healthcare and public health measures. In some countries, health system planning is distributed among market participants. In others, there is a concerted effort among governments, trade unions, charities, religious organizations, or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve.

An efficient health care 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. An example of this was the worldwide eradication of smallpox in 1980, declared by the World Health Organization (WHO) as the first disease in human history to be completely eliminated by deliberate health care interventions.^[11]

Health care industry

The healthcare industry (also called the medical industry or health economy) is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. It depends on interdisciplinary teams of trained professionals and paraprofessionals to meet the health needs of individuals and populations. 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.

The health care 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 the activities of nurses, midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics, residential health facilities, and patient advocates^[12]

The modern healthcare industry is one of the world's largest and fastest-growing industries. Consuming over 10 percent of gross domestic product (GDP) of most developed nations, health care can form an significant part of a country's economy. The industry is experiencing rapid development: from surgical robots to smart hospitals the digital transformation is revolutionizing health care. When thinking about technology in the healthcare industry, and specifically medical technology, there are several crucial factors to consider. With its government mandated need for security, massive amounts of sensitive data and rapidly changing technological environment, healthcare is among the economic sectors facing the most significant challenges in implementing effective IT solutions. From small doctor’s offices to major hospitals, the healthcare IT environment is increasingly complex and, if not managed appropriately, can negatively impact patient care.

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 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.^[13] Health services research is 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.^[14]

Health care financing

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

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 is how much to spend on healthcare. For the purposes of comparison, this is often expressed as the percentage of GDP spent on health care.

In 2018, spending on health was about US$ 4,000 per capita (adjusted for purchasing powers), on average across OECD countries; 8.8 percent of GDP. This amount is expected to increase despite reforms to reduce costs through increased use of generic medications, increases in day surgery, lower hospitalization rates, and shorter stays. One factor leading to increased costs is the ageing of the population which increases demand for health services, particularly for long‑term care.^[15]

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."^[16]

Health information technology components:

• Electronic Health Record (EHR) - An EHR contains a patient's comprehensive medical history, and may include records from multiple providers.
• Electronic Medical Record (EMR) - An EMR contains the standard medical and clinical data gathered in one's provider's office.
• Personal Health Record (PHR) - A PHR is a patient's medical history that is maintained privately, for personal use.^[17]
• 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).
• 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.^[18]

Notes

References

ISBN links support NWE through referral fees

• Askin, Elisabeth, Nathan Moore, and Vikram Shankar. The Health Care Handbook: A Clear & Concise Guide to the United States Health Care System. Washington University in St Louis, 2014. ISBN 978-0692244739
• Bond, John, and Senga Bond. Sociology and Health Care. Churchill Livingstone, 1994. ISBN 978-0443040597
• Dal Poz, M.R., N. Gupta, E. Quain, and A.L.B. Soucat (eds.). Handbook on Monitoring and Evaluation of Human Resources for Health. Geneva, World Health Organization, 2009. ISBN 978-9241547703
• Institute of Medicine. Access to Health Care in America. National Academies Press, 1993. ISBN 978-0309047425
• Knickman, James R. and Brian Elbel (eds.). Jonas and Kovner's Health Care Delivery in the United States. Springer Publishing Company, 2018. ISBN 978-0826172723

External links

All links retrieved April 8, 2020.

• World Health Organization
• Health Care Systems American Hospital Association
• Introduction to the Healthcare System Colorado Patient Navigator Training Program
• What is “healthcare?” Medical Economics.

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