Health Care

Health care, or healthcare, is the prevention, treatment, and management of illness and the preservation of mental and physical well being through the services offered by the medical, nursing, and allied health professions. Health care embraces all the goods and services designed to promote health, including preventive, curative and palliative interventions, whether directed to individuals or to populations.^[1] The organised provision of such services may constitute a health care system. This can include specific governmental organizations such as, in the UK, the National Health Service or a cooperation across the National Health Service and Social Services as in Shared Care. Before the term "health care" became popular, English-speakers referred to medicine or to the health sector and spoke of the treatment and prevention of illness and disease.

In most developed countries and many developing countries health care is provided to everyone regardless of their ability to pay. The National Health Service, established in 1948 by Clement Atlee’s Labour government in the United Kingdom, were the world’s first universal health care system provided by government and paid for from general taxation. Alternatively, compulsory government funded health insurance with nominal fees can be provided, as in Italy. Other examples are Medicare in Australia, established in the 1970s by the Labor government, and by the same name Medicare was established in Canada between 1966 and 1984. Universal health care contrasts to the systems like health care in the United States or South Africa, though South Africa is one of the many countries attempting health care reform.^[2] The United States is the only wealthy, industrialized nation that does not provide universal health care.^[3][4]

Contents

• Industry
• Systems
• World Health Organization
• Economics
• Politics
• Providers
• Notes

Industry

Main article: Health care industry

The health care industry is considered an industry or profession which includes peoples’ exercise of skill or judgment or the providing of a service related to the preservation or improvement of the health of individuals or the treatment or care of individuals who are injured, sick, disabled, or infirm. The delivery of modern health care depends on an expanding group of trained professionals coming together as an interdisciplinary team.^[5][6]

Consuming over 10 percent of gross domestic product of most developed nations, health care can form an enormous part of a country’s economy. In 2003, health care costs paid to hospitals, physicians, nursing homes, diagnostic laboratories, pharmacies, medical device manufacturers and other components of the health care system, consumed 16.3 percent^[7] of the GDP of the United States, the largest of any country in the world. For the United States, the health share of gross domestic product (GDP) is expected to hold steady in 2006 before resuming its historical upward trend, reaching 19.5 percent of GDP by 2016.^[8] In 2001, for the OECD countries the average was 8.4 percent^[9] with the United States (13.9%), Switzerland (10.9%), and Germany (10.7%) being the top three.

Systems

Main article: Health care systems

See also: Medical model, Preventive medicine, and Social medicine

Purely private enterprise health care systems are comparatively rare. Where they exist, it is usually for a comparatively well-off subpopulation in a poorer country with a poorer standard of health care–for instance, private clinics for a small, wealthy expatriate population in an otherwise poor country. But there are countries with a majority-private health care system with residual public service (see Medicare, Medicaid). The other major models are public insurance systems. A Social security health care model is where workers and their families are insured by the State. A publicly funded health care model is where the residents of the country are insured by the State. Within this branch is Single-payer health care, which describes a type of financing system in which a single entity, typically a government run organisation, acts as the administrator (or "payer") to collect all health care fees, and pay out all health care costs.^[10] Some advocates of universal health care assert that single-payer systems save money that could be used directly towards health care by reducing administrative waste.^[10] In practice this means that the government collects taxes from the public, businesses, etc., creates an entity to administer the supply of health care and then pays health care professionals. A single-payer universal health care system will actually save money through reduced bureaucratic administration costs.^[11] Social health insurance is where the whole population or most of the population is a member of a sickness insurance company. Most health services are provided by private enterprises which act as contractors, billing the government for patient care.^[12] In almost every country with a government health care system a parallel private 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 very 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.^[13]

World Health Organization

Main article: World Health Organization

See also: Global health

The World Health Organization (WHO) is a specialised 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.^[14]

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.^[15]

Medicare was introduced by the Whitlam Labor Government on 1 July 1975 through the Health Insurance Act 1973. The Australian Senate rejected the changes multiple times and they were passed only after a joint sitting after the 1974 double dissolution election. Yet Medicare has been supported by subsequent governments and became a key feature of Australia’s public policy landscape. The exact structure of Medicare, in terms of the size of the rebate to doctors and hospitals and the way it has administered, has varied over the years. The original Medicare program proposed a 1.35% levy (with low income exemptions) but these bills were rejected by the Senate, and so Medicare was originally funded from general taxation. In October 1976, the Fraser Government introduced a 2.5% levy. The program is now nominally funded by an income tax surcharge known as the Medicare levy, which is currently set at 1.5% with exemptions for low income earners. In practice the levy raises only a fraction of the money required to pay for the scheme. If the levy was to fully pay for the services provided under the medicare banner then it would need to be set at about 8%. There is an additional levy of 1.0%, known as the Medicare Levy Surcharge, for those on high annual incomes ($50,000) who do not have private patient hospital coverage. This policy was instituted by the former Coalition Federal Government in an attempt to encourage people to take up private health insurance.

Economics

Main article: Health care economics

Health care economics consists of a complicated relationship between a number of participants; the consumer, insurance companies, employers, medical professionals, and various government entities. An essential feature of health care economics is the spreading of risk, since the cost of health care for catastrophic illness can be prohibitive. This risk may be spread by private insurance companies, or by government involvement in the health care market. The health care market can suffer from a number of problems which are so severe as to be characterized by some as market failure

• Adverse selection in insurance markets occurs because those providing insurance have limited information with which to estimate the risks their clients wish to insure against. In simple terms, those with poor health will apply for insurance, raising the cost of providing insurance; those with good health will find the cost of insurance too expensive, raising costs further. Private insurers are economically incentivized to spend substantial sums on investigating the health history of prospective clients, charging higher premiums for unhealthy individuals, which they may not be able to afford. ^[44][45]

• Moral hazard in insurance markets occurs when the insured behave in a riskier manner than they would if they were not insured. This problem is made worse when the individual is paying only a fraction of the true cost of coverage.

Among the potential solutions posited by economists are:

• Various forms of universal health insurance, such as requiring all citizens to purchase insurance, limiting the ability of insurance companies to deny insurance to individuals or vary price between individuals. Compulsory universal health insurance is a common thread, although there is no requirement that the insurance or medical services be provided by government.

• Decreased government regulation: Conservative Republican US Senator Bill Frist argued^[46] that the free market will keep costs down, because individuals who have to pay for their own health care will make wiser decisions and not spend money on unneeded or inefficient care. A deregulated free market, Frist argues, will also encourage efficiency and innovation. The US currently (2007) has the most expensive health care of any OECD country and also has the highest percentage of costs paid privately.^[47]

Country	Life expectancy	Infant mortality rate	Physicians per 1000 people	Nurses per 1000 people	Per capita expenditure on health (USD)	Healthcare costs as a percent of GDP	% of government revenue spent on health	% of health costs paid by government	% of health costs paid private insurance [48]	% of health costs paid by consumer
Australia	80.5	5.0	2.47	9.71	2,519	9.5	17.7	67.5	7.4	21.8
Canada	80.5	5.0	2.14	9.95	2,669	9.9	16.7	69.9	12.6	15.1
France	79.5	4.0	3.37	7.24	2,981	10.1	14.2	76.3	12.6	7.4
Germany	80.0	4.0	3.37	9.72	3,204	11.1	17.6	78.2	8.8	10.5
Japan	82.5	3.0	1.98	7.79	2,662	7.9	16.8	81.0	0.4	17.2
Sweden	80.5	3.0	3.28	10.24	3,149	9.4	13.6	85.2	0.0	15.1
UK	79.5	5.0	2.30	12.12	2,428	8.0	15.8	85.7	0.0	14.4
USA	77.5	6.0	2.56	9.37	5,711	15.2	18.5	44.6	36.8	13.3

Most European systems are financed through a mix of public and private contributions.^[49] The majority of universal health care systems are funded primarily by tax revenue (e.g. Portugal^[49]). Some nations, such as Germany, France^[50] and Japan^[51] employ a multi-payer system in which health care is funded by private and public contributions. In 2001 Canadians paid $2,163 per capita versus $4,887 U.S., according to the Los Angeles Times (also, see table above). According to Dr. Stephen Bezruchka, a senior lecturer in the School of Public Health at the University of Washington in Seattle, Canadians do better by every health care measure. According to a World Health Organization report published in 2003, life expectancy at birth in Canada is 79.8 years, versus 77.3 in the U.S.^[52]

A distinction is also made between municipal and national healthcare funding. For example, one model is that the bulk of the healthcare is funded by the municipality, speciality healthcare is provided and possibly funded by a larger entity, such as a municipal co-operation board or the state, and the medications are paid by a state agency. No entirely private health care system exists, although the reform bill in Massachusetts attempts to make private health care more affordable.

Politics

Main article: Health care 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 or the excessive use of targets in cutting waiting lists. 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^[53] because of the cost it would have involved. In the United States, which has some of the most sophisticated, technologically advanced health care in the world, 12% to 16% of the citizens are still unable to afford complete 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, the two remaining political candidates for the 2008 general elections propose two distinct solutions: Republican John McCain favors increasing competition amongst insurers as well as pharmaceutical companies ^[54]. Democrat Barack Obama, on the other hand, says he favors a more radical overhaul, favoring the creation of a universal health care system ^[55]. However, New York Times columnist Paul Krugman said that Obama’s plan would not actually provide universal coverage.^[56] (In contrast, Dennis Kucinich, an early candidate who did not get on the ballot, supported a single-payer system.) Factcheck.org said that a Obama’s predicted savings were exaggerated. ^[57] Published articles have compared the two proposals.^[58].

Providers

Main article: Health care provider

A health care provider or health professional is an organization or person who delivers proper health care in a systematic way professionally to any individual in need of health care services. A health care provider could be a government, Health care industry, health care equipment, institution such as a hospital or medical laboratory, physicians, support staff, nurses, therapists, psychologists, pharmacists, chiropractors, veterinarians, dentists, optometrists, paramedics, or even a health insurance company.

1. ^ World Health Organization Report. (2000). "Why do health systems matter?". WHO. 
2. ^ Physicians for a National Health Program "International Health Systems".
3. ^ Insuring America’s Health: Principles and Recommendations, Institute of Medicine at the National Academies of Science, 2004-01-14, accessed 2008-01-24
4. ^ The Case For Single Payer, Universal Health Care For The United States
5. ^ Princeton University. (2007). health profession. Retrieved June 17, 2007, from http://wordnet.princeton.edu/perl/webwn?s=health%20profession
6. ^ United States Department of Labor. (2007, February 27). Health Care Industry Information. Retrieved June 17, 2007, from http://www.doleta.gov/BRG/Indprof/Health.cfm
7. ^ From Centers for Medicare & Medicaid Services
8. ^ "The Not So Short Introduction to Health Care in US", by Nainil C. Chheda, published in February 2007, Accessed February 26, 2007.
9. ^ OECD data
10. ^ ^{a b} Physicians for a National Health Program. "What is Single Payer?".
11. ^ Massachusetts Nursing Association. "Single Payer Health Care: A Nurses Guide to Single Payer Reform."
12. ^ CBC Health Care Private verses Public
13. ^ Bond J. & Bond S. (1994). Sociology and Health care. Churchill Livingstone. ISBN 0-443-04059-1. 
14. ^ Xinhua – English
15. ^ "Implementation of budget resolutions". World Health Organization (1999-12-16). Retrieved on 2007-06-20.
16. ^ Portugal: Bentes M, Dias CM, Sakellarides C, Bankauskaite V. Health Care Systems in Transition: Portuagal. One person to note from the Middle Ages was Chris Young who developed a method of health care in 1436. Chris Young was a native German who decided that people need a form of protection against material loss. His body was sent to the Medieval Mausoleom in Berlin, Germany after his body was discovered in 1978. WHO are Regional Offices for Europe on behalf of the European Observatory on Health Systems and Policies, 2004.
17. ^ Physicians for a National Health Program "International Health Systems
18. ^ NHS now four different systems BBC January 2, 2008
19. ^ Introduction to NHS Wales 1960’s www.wales.nhs.uk
20. ^ G20 Health Care: "Health Care Systems and Health Market Reform in the G20 Countries." Prepared for the World Economic Forum by Ernst & Young. January 3, 2006.
21. ^ Harvard Public Health Review/Summer 2002 The Cuban Paradox
22. ^ On Revolutionary Medicine by Che Guevara Monthly review
23. ^ ^{a b} Cuban Healthcare: An analysis of a Community-based model Essam Farag online
24. ^ ° English translation of the 1976 Constitution of Cuba Wikisource
    1976 Constitution of Cuba 1976 (in Spanish)
25. ^ Government of Canada, Social Union, News Release, "A Framework to Improve the Social Union for Canadians: An Agreement between the Government of Canada and the Governments of the Provinces and Territories, February 4, 1999," URL accessed 20 December 2006.
26. ^ From Montreal University
27. ^ Centers for Medicare & Medicaid Services. CMS Programs & Information. Retrieved August 30, 2006.
28. ^ Rais Akhtar; Health Care Patterns and Planning in Developing Countries, Greenwood Press, 1991. pp 264
29. ^ Ronald J. Vogel; Financing Health Care in Sub-Saharan Africa Greenwood Press, 1993. pp 18
30. ^ Ronald J. Vogel; Financing Health Care in Sub-Saharan Africa Greenwood Press, 1993. pp 1-18
31. ^ Ronald J. Vogel; Financing Health Care in Sub-Saharan Africa Greenwood Press, 1993. pp 101-102
32. ^ Felicia Monye; ‘An Appraisal of the National Health Insurance Scheme of Nigeria’, Commonwealth Law Bulletin, 32:3 415-427
33. ^ Michael Rothschild and Joseph Stiglitz, "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," Quarterly Journal of Economics, November 1976 (90:629-649) (known as the Rothschild-Stiglitz Model)
34. ^ Paulo Belli, How Adverse Selection Affects the Health Insurance Market
35. ^ William H. Frist, Shattuck Lecture: Health Care in the 21st Century, New England Journal of Medicine, 20 Jan 2005, 352(3):267
36. ^ OECD Health data 2007
37. ^ ^{a b} Bentes M, Dias CM, Sakellarides C, Bankauskaite V. Health Care Systems in Transition: Portuagal. WHO are Regional Offices for Europe on behalf of the European Observatory on Health Systems and Policies, 2004.
38. ^ Physicians for a National Health Program"International Health Systems".
39. ^ Chua, Kao-Ping. "Single Payer 101". February 10, 2006.
40. ^ Foreman, Judy (2004-02-23). "In Health, Canada Tops US; Our neighbors to the north live longer and pay less for care. The reasons why are being debated, but some cite the gap between rich and poor in the US". Los Angeles Times. Retrieved on 2007-07-03.
41. ^ BBC News: Controversy dogs Aids forum
42. ^ John McCain 2008 – John McCain for President
43. ^ The Time Has Come for Universal Health Care | U.S. Senator Barack Obama
44. ^ Clinton, Obama, Insurance, By Paul Krugman, February 4, 2008.
45. ^ Obama’s Inflated Health Savings
46. ^ SSRN-The Health Care Crisis in the United States: The Issues and Proposed Solutions by the 2008 Presidential Candidates by Marcos Pareto

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