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Health care

Health care attempts to improve health by prevention, diagnosing, treating, ameliorating or curing 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.

Health care includes work done in providing primary care, secondary care, and tertiary care, as well as in public health.

Access to health care varies across countries, communities, and individuals, influenced by social and economic conditions as well as health policies. 

Providing health care services goals are the  timely use of personal health services to achieve the best possible health outcomes.

Health care access factors include : financial limitations, such as insurance coverage, geographical and logistical barriers, sociocultural expectations, and personal limitations of ability to communicate with health care providers, health literacy, and income.

Limitations to health care services affects negatively the use of medical services, the efficacy of treatments, and overall well-being, and mortality rates.

Health care system requires a financing mechanism, trained and adequately paid workforce, 

The health care system relies on reliable information on which to base decisions and policies, and well-maintained health facilities to deliver quality medicines and technologies.

An efficient health care system can contributes to a country’s economy, development, and industrialization. 

Health care is regarded as an important determinant in promoting the general physical and mental health and well-being of populations.

Primary care constitutes the first line of a health care process and may also include the provision of secondary and tertiary levels of care.

The emergency department is often a frontline venue for the delivery of primary medical care.

Health care can be defined as either public or private.

Primary care refers to the first point of consultation for all patients to the health care system: usually a primary care physician, such as a general practitioner or family physician, or an independent practitioner such as a physiotherapist, or a non-physician primary care provider such as a physician assistant or nurse practitioner. 

Depending on the locality, 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 is a the term used for the health care services that play a role in the local community. 

Primary care involves the widest scope of health care.

Primary care involves all ages of 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. 

A primary care practitioner must possess a wide brknowledge in many areas. 

Continuity is a key characteristic of primary care.

Common chronic illnesses 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. 

Older studies in the United States, the 2013 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.

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.

Primary care as an integral component of an inclusive primary health care strategy.

Secondary acute care: requires necessary treatment for a short period of time for a brief but serious illness, injury, or other health condition. 

Secondary acute care is often found in a hospital emergency department. 

Secondary care also includes skilled attendance during childbirth, intensive care, and medical imaging services.

Tertiary care services onclude: cancer management, neurosurgery, cardiac surgery, plastic surgery, burn management, advanced neonatology services, palliative, and other complex medical and surgical interventions.

Many types of health care interventions are delivered outside of health facilities including  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.

Health care ratings: 

hospital quality

health plan quality

physician quality

quality for other health professionals

of patient experience

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.

Five  primary methods of funding health care systems exist: 

General taxation to the state, county or municipality

Social health insurance

Voluntary or private health insurance

Out-of-pocket payments

Donations to health charities

Most countries, have a mix of all five methods, but this varies across countries and over time within countries. 

In OECD countries for every extra $1000 spent on health care, life expectancy falls by 0.4 years: the notion that more funding is better is not supported by the data.

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.

In the United States, where around 18% of GDP is spent on health care,

The  Commonwealth Fund analysis of spend and quality shows a correlation between worse quality and higher spending.

Most countries have credentialing staff in regulatory boards or health departments who document the certification or licensing of health workers and their work history.

Health information technology (HIT) is providing information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care data, and communication and decision making.

Electronic Health Record (EHR) – An EHR contains a patient’s comprehensive medical history, and may include records from multiple providers.

An EMR contains the standard medical and clinical data gathered about the patient.

Health Information Exchange allows health care professionals and patients to appropriately access and securely share a patient’s vital medical information electronically

Independent medical practices and solo community hospitals are disappearing as they are being acquired by hospital based health systems. 

84 to 91% of US hospitals and 40 to 50% of physicians are part of health systems. 

 

2011 health care spending was $2.7 trillion or 17.9% of the gross domestic product.

Health care sector employs 21 million people, and accounts for 15.7% of the US workforce.

In 2011 there were 2.7 million nurses and 800,000 physicians in the US.

Administrative costs have doubled from 3% in 1980 to 7% in 2010 with the growth of 5.6% per year.

Recently the rate for average yearly increases of total expenditures has declined.

Total cost of health care is affected by price, population, and demand.

Globally, suboptimal quality of healthcare accounts for 10-15% of mortality, which is 5.7 million-8.4 million deaths, annually.
It is estimated that US adults receive about 55% of the recommended care for the leading causes of death and disease.
Patients with multiple chronic conditions or at particular risk for poor quality of care because of the requirement of multiple specialists increases fragmentation of care, increases the likelihood of medical errors, poor outcomes, and lower quality of life and higher cost.

Barriers to effective care for people with multiple chronic conditions include physical distance, financial costs, and shortage of facilities.

Cancer is the second most costly disease in the US, and accounts for 5-11% of the annual total healthcare budget.

The increase in health care as a portion of the economy can be accounted for by the failure of the rest of the economy to increase much at all.

The increases in price, particularly of drugs, medical devices, and hospital care, and not the intensity of service or demographic change has produced most of the increase in health care share of GDP.

Commercial insurance payers spend almost twice as much on chemotherapy compared with therapy administered in physician offices (JAMA).

Americans spend more on health care, but have shorter life spans.

Americans spend nearly twice as much on health care as other wealthy countries, but it’s not doing much to improve their health.

The United States has the shortest life expectancy and highest infant and maternal mortality rates among any of its peers.

Steep spending on drugs and doctor’s salaries are among the major drivers of the high cost of health care in the United States.

Contrary to popular belief, Americans don’t use more health care than residents in other countries.

Health care spending accounted for 17.8% of the US economy in 2016, compared to an average of 11.5% in the 11 high-income countries studied.

Americans spent $9,400 per capita on health care that year, compared to an average of $5,400 in the peer nations, which include Canada, Japan, Australia and several Western European countries.

Health care usage in the United States was relatively similar to the other countries.

Americans had lower rates of physician visits and spent fewer days in the hospital, though they had some of the highest rates for imaging tests, such as MRIs and CT scans, and some common surgical procedures, such as knee replacements, cataract surgeries and cesarean births.

Per capita spending on prescription drugs was more than $1,400, compared to an average of $750 for all nations studied.

For several commonly used medications, the American price was more than double what it was in the country with the next highest cost.

The average salary for a general practice physician in the United States was more than $218,000, compared to an average of nearly $134,000 in the peer nations.

Physician specialists are paid $316,000, compared to nearly $183,000, while nurses earn more than $74,000, compared to just under $52,000 for peer nations.

The American health care system spends far more on administrative costs, coming in at 8% of total health care spending, compared to between 1% and 3% for other countries.

The average life expectancy in the United States is 78.8 years, compared to an average of 81.7 years for the peer nations studied.

The United States also has the highest infant mortality rate, with nearly six deaths out of 1,000 live births, compared to an average of 3.6 deaths elsewhere.

The maternal mortality rate, with more than 26 out of 100,000 women dying from birth- or pregnancy-related complications, compared to an average rate of 8.4 women in other nations.

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