A health system, health care system or healthcare system is an organization of people, institutions, and resources that delivers health care services to meet the health needs of target populations.
There is a wide variety of health systems around the world, with as many histories and organizational structures as there are countries. Implicitly, countries must 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.[1]
In certain countries, the orchestration of health system planning is decentralized, with various stakeholders in the market assuming responsibilities. In contrast, in other regions, a collaborative endeavor exists among governmental entities, labor unions, philanthropic organizations, religious institutions, or other organized bodies, aimed at the meticulous provision of healthcare services tailored to the specific needs of their respective populations. Nevertheless, it is noteworthy that the process of healthcare planning is frequently characterized as an evolutionary progression rather than a revolutionary transformation.[2][3]
As with other social institutional structures, health systems are likely to reflect the history, culture and economics of the states in which they evolve. These peculiarities bedevil and complicate international comparisons and preclude any universal standard of performance.
According to the World Health Organization (WHO), the directing and coordinating authority for health within the United Nations system, healthcare systems' goals are good health for the citizens, responsiveness to the expectations of the population, and fair means of funding operations. Progress towards them depends on how systems carry out four vital functions: provision of health care services, resource generation, financing, and stewardship.[4] Other dimensions for the evaluation of health systems include quality, efficiency, acceptability, and equity.[2] They have also been described in the United States as "the five C's": Cost, Coverage, Consistency, Complexity, and Chronic Illness.[5] Also, continuity of health care is a major goal.[6]
Often health system has been defined with a reductionist perspective. Some authors[7] have developed arguments to expand the concept of health systems, indicating additional dimensions that should be considered:
The World Health Organization defines health systems as follows:
A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health as well as more direct health-improving activities. A health system is, therefore, more than the pyramid of publicly owned facilities that deliver personal health services. It includes, for example, a mother caring for a sick child at home; private providers; behaviour change programmes; vector-control campaigns; health insurance organizations; occupational health and safety legislation. It includes inter-sectoral action by health staff, for example, encouraging the ministry of education to promote female education, a well-known determinant of better health.[8]
There are generally five primary methods of funding health systems:[9]
| Universal | Non-universal | |||
|---|---|---|---|---|
| Single payer | Multi-payer | Multi-payer | No insurance | |
| Single provider | Beveridge model, Semashko model | |||
| Multiple Providers | National Health Insurance | Bismarck model | Private health insurance | Out-of-pocket |
Most countries' systems feature a mix of all five models. One study[10] based on data from the OECD concluded that all types of health care finance "are compatible with" an efficient health system. The study also found no relationship between financing and cost control.[citation needed] Another study examining single payer and multi payer systems in OECD countries found that single payer systems have significantly less hospital beds per 100,000 people than in multi payer systems.[11]
The term health insurance is generally used to describe a form of insurance that pays for medical expenses. It is sometimes used more broadly to include insurance covering disability or long-term nursing or custodial care needs. It may be provided through a social insurance program, or from private insurance companies. It may be obtained on a group basis (e.g., by a firm to cover its employees) or purchased by individual consumers. In each case premiums or taxes protect the insured from high or unexpected health care expenses.[citation needed]
Through the calculation of the comprehensive cost of healthcare expenditures, it becomes feasible to construct a standard financial framework, which may involve mechanisms like monthly premiums or annual taxes. This ensures the availability of funds to cover the healthcare benefits delineated in the insurance agreement. Typically, the administration of these benefits is overseen by a government agency, a nonprofit health fund, or a commercial corporation.[12]
Many commercial health insurers control their costs by restricting the benefits provided, by such means as deductibles, copayments, co-insurance, policy exclusions, and total coverage limits. They will also severely restrict or refuse coverage of pre-existing conditions. Many government systems also have co-payment arrangements but express exclusions are rare or limited because of political pressure. The larger insurance systems may also negotiate fees with providers.[citation needed]
Many forms of social insurance systems control their costs by using the bargaining power of the community they are intended to serve to control costs in the health care delivery system. They may attempt to do so by, for example, negotiating drug prices directly with pharmaceutical companies, negotiating standard fees with the medical profession, or reducing unnecessary health care costs. Social systems sometimes feature contributions related to earnings as part of a system to deliver universal health care, which may or may not also involve the use of commercial and non-commercial insurers. Essentially the wealthier users pay proportionately more into the system to cover the needs of the poorer users who therefore contribute proportionately less. There are usually caps on the contributions of the wealthy and minimum payments that must be made by the insured (often in the form of a minimum contribution, similar to a deductible in commercial insurance models).[citation needed]
In addition to these traditional health care financing methods, some lower income countries and development partners are also implementing non-traditional or innovative financing mechanisms for scaling up delivery and sustainability of health care,[13] such as micro-contributions, public-private partnerships, and market-based financial transaction taxes. For example, as of June 2011, Unitaid had collected more than one billion dollars from 29 member countries, including several from Africa, through an air ticket solidarity levy to expand access to care and treatment for HIV/AIDS, tuberculosis and malaria in 94 countries.[14]
In most countries, wage costs for healthcare practitioners are estimated to represent between 65% and 80% of renewable health system expenditures.[15][16] There are three ways to pay medical practitioners: fee for service, capitation, and salary. There has been growing interest in blending elements of these systems.[17]
Fee-for-service arrangements pay general practitioners (GPs) based on the service.[17] They are even more widely used for specialists working in ambulatory care.[17]
There are two ways to set fee levels:[17]
In capitation payment systems, GPs are paid for each patient on their "list", usually with adjustments for factors such as age and gender.[17] According to OECD (Organization for Economic Co-operation and Development), "these systems are used in Italy (with some fees), in all four countries of the United Kingdom (with some fees and allowances for specific services), Austria (with fees for specific services), Denmark (one third of income with remainder fee for service), Ireland (since 1989), the Netherlands (fee-for-service for privately insured patients and public employees) and Sweden (from 1994). Capitation payments have become more frequent in "managed care" environments in the United States."[17]
According to OECD, "capitation systems allow funders to control the overall level of primary health expenditures, and the allocation of funding among GPs is determined by patient registrations". However, under this approach, GPs may register too many patients and under-serve them, select the better risks and refer on patients who could have been treated by the GP directly. Freedom of consumer choice over doctors, coupled with the principle of "money following the patient" may moderate some of these risks. Aside from selection, these problems are likely to be less marked than under salary-type arrangements.'[citation needed]
In several OECD countries, general practitioners (GPs) are employed on salaries for the government.[17] According to OECD, "Salary arrangements allow funders to control primary care costs directly; however, they may lead to under-provision of services (to ease workloads), excessive referrals to secondary providers and lack of attention to the preferences of patients."[17] There has been movement away from this system.[17]
In recent years, providers have been switching from fee-for-service payment models to a value-based care payment system, where they are compensated for providing value to patients. In this system, providers are given incentives to close gaps in care and provide better quality care for patients. [18]
Sound information plays an increasingly critical role in the delivery of modern health care and efficiency of health systems. Health informatics – the intersection of information science, medicine and healthcare – deals with the resources, devices, and methods required to optimize the acquisition and use of information in health and biomedicine. Necessary tools for proper health information coding and management include clinical guidelines, formal medical terminologies, and computers and other information and communication technologies. The kinds of health data processed may include patients' medical records, hospital administration and clinical functions, and human resources information.[19]
The use of health information lies at the root of evidence-based policy and evidence-based management in health care. Increasingly, information and communication technologies are being utilised to improve health systems in developing countries through: the standardisation of health information; computer-aided diagnosis and treatment monitoring; informing population groups on health and treatment.[20]
The management of any health system is typically directed through a set of policies and plans adopted by government, private sector business and other groups in areas such as personal healthcare delivery and financing, pharmaceuticals, health human resources, and public health.[citation needed]
Public health is concerned with threats to the overall health of a community based on population health analysis. The population in question can be as small as a handful of people, or as large as all the inhabitants of several continents (for instance, in the case of a pandemic). Public health is typically divided into epidemiology, biostatistics and health services. Environmental, social, behavioral, and occupational health are also important subfields.[citation needed]
Today, most governments recognize the importance of public health programs in reducing the incidence of disease, disability, the effects of ageing and health inequities, although public health generally receives significantly less government funding compared with medicine. For example, most countries have a vaccination policy, supporting public health programs in providing vaccinations to promote health. Vaccinations are voluntary in some countries and mandatory in some countries. Some governments pay all or part of the costs for vaccines in a national vaccination schedule.[citation needed]
The rapid emergence of many chronic diseases, which require costly long-term care and treatment, is making many health managers and policy makers re-examine their healthcare delivery practices. An important health issue facing the world currently is HIV/AIDS.[21] Another major public health concern is diabetes.[22] In 2006, according to the World Health Organization, at least 171 million people worldwide had diabetes. Its incidence is increasing rapidly, and it is estimated that by 2030, this number will double. A controversial aspect of public health is the control of tobacco smoking, linked to cancer and other chronic illnesses.[23]
Antibiotic resistance is another major concern, leading to the reemergence of diseases such as tuberculosis. The World Health Organization, for its World Health Day 2011 campaign, called for intensified global commitment to safeguard antibiotics and other antimicrobial medicines for future generations.[citation needed]
Since 2000, more and more initiatives have been taken at the international and national levels in order to strengthen national health systems as the core components of the global health system. Having this scope in mind, it is essential to have a clear, and unrestricted, vision of national health systems that might generate further progress in global health. The elaboration and the selection of performance indicators are indeed both highly dependent on the conceptual framework adopted for the evaluation of the health systems performance.[25] Like most social systems, health systems are complex adaptive systems where change does not necessarily follow rigid management models.[26] In complex systems path dependency, emergent properties and other non-linear patterns are seen,[27] which can lead to the development of inappropriate guidelines for developing responsive health systems.[28]
Quality frameworks are essential tools for understanding and improving health systems. They help define, prioritize, and implement health system goals and functions. Among the key frameworks is the World Health Organization's building blocks model, which enhances health quality by focusing on elements like financing, workforce, information, medical products, governance, and service delivery. This model influences global health evaluation and contributes to indicator development and research.[29]
The Lancet Global Health Commission's 2018 framework builds upon earlier models by emphasizing system foundations, processes, and outcomes, guided by principles of efficiency, resilience, equity, and people-centeredness. This comprehensive approach addresses challenges associated with chronic and complex conditions and is particularly influential in health services research in developing countries.[30] Importantly, recent developments also highlight the need to integrate environmental sustainability into these frameworks, suggesting its inclusion as a guiding principle to enhance the environmental responsiveness of health systems.[31]
An increasing number of tools and guidelines are being published by international agencies and development partners to assist health system decision-makers to monitor and assess health systems strengthening[32] including human resources development[33] using standard definitions, indicators and measures. In response to a series of papers published in 2012 by members of the World Health Organization's Task Force on Developing Health Systems Guidance, researchers from the Future Health Systems consortium argue that there is insufficient focus on the 'policy implementation gap'. Recognizing the diversity of stakeholders and complexity of health systems is crucial to ensure that evidence-based guidelines are tested with requisite humility and without a rigid adherence to models dominated by a limited number of disciplines.[28][34] Healthcare services often implement Quality Improvement Initiatives to overcome this policy implementation gap. Although many of these initiatives deliver improved healthcare, a large proportion fail to be sustained. Numerous tools and frameworks have been created to respond to this challenge and increase improvement longevity. One tool highlighted the need for these tools to respond to user preferences and settings to optimize impact.[35]
Health Policy and Systems Research (HPSR) is an emerging multidisciplinary field that challenges 'disciplinary capture' by dominant health research traditions, arguing that these traditions generate premature and inappropriately narrow definitions that impede rather than enhance health systems strengthening.[36] HPSR focuses on low- and middle-income countries and draws on the relativist social science paradigm which recognises that all phenomena are constructed through human behaviour and interpretation. In using this approach, HPSR offers insight into health systems by generating a complex understanding of context in order to enhance health policy learning.[37] HPSR calls for greater involvement of local actors, including policy makers, civil society and researchers, in decisions that are made around funding health policy research and health systems strengthening.[38]
Expand the OECD charts below to see the breakdown:
Health systems can vary substantially from country to country, and in the last few years, comparisons have been made on an international basis. The World Health Organization, in its World Health Report 2000, provided a ranking of health systems around the world according to criteria of the overall level and distribution of health in the populations, and the responsiveness and fair financing of health care services.[4] The goals for health systems, according to the WHO's World Health Report 2000 – Health systems: improving performance (WHO, 2000),[42] are good health, responsiveness to the expectations of the population, and fair financial contribution. There have been several debates around the results of this WHO exercise,[43] and especially based on the country ranking linked to it,[44] insofar as it appeared to depend mostly on the choice of the retained indicators.
Direct comparisons of health statistics across nations are complex. The Commonwealth Fund, in its annual survey, "Mirror, Mirror on the Wall", compares the performance of the health systems in Australia, New Zealand, the United Kingdom, Germany, Canada and the United States. Its 2007 study found that, although the United States system is the most expensive, it consistently underperforms compared to the other countries.[45] A major difference between the United States and the other countries in the study is that the United States is the only country without universal health care. The OECD also collects comparative statistics, and has published brief country profiles.[46][47][48] Health Consumer Powerhouse makes comparisons between both national health care systems in the Euro health consumer index and specific areas of health care such as diabetes[49] or hepatitis.[50]
Ipsos MORI produces an annual study of public perceptions of healthcare services across 30 countries.[51]
| Country | Life expectancy[52] | Infant mortality rate[53] | Preventable deaths per 100,000 people in 2007[54] | Physicians per 1000 people | Nurses per 1000 people | Per capita expenditure on health (USD PPP) | Healthcare costs as a percent of GDP | % of government revenue spent on health | % of health costs paid by government |
|---|---|---|---|---|---|---|---|---|---|
| Australia | 83.0 | 4.49 | 57 | 2.8 | 10.1 | 3,353 | 8.5 | 17.7 | 67.5 |
| Canada | 82.0 | 4.78 | 77[55] | 2.2 | 9.0 | 3,844 | 10.0 | 16.7 | 70.2 |
| Finland | 79.5 | 2.6 | 2.7 | 15.5 | 3,008 | 8.4 | |||
| France | 82.0 | 3.34 | 55 | 3.3 | 7.7 | 3,679 | 11.6 | 14.2 | 78.3 |
| Germany | 81.0 | 3.48 | 76 | 3.5 | 10.5 | 3,724 | 10.4 | 17.6 | 76.4 |
| Italy | 83.0 | 3.33 | 60 | 4.2 | 6.1 | 2,771 | 8.7 | 14.1 | 76.6 |
| Japan | 84.0 | 2.17 | 61 | 2.1 | 9.4 | 2,750 | 8.2 | 16.8 | 80.4 |
| Norway | 83.0 | 3.47 | 64 | 3.8 | 16.2 | 4,885 | 8.9 | 17.9 | 84.1 |
| Spain | 83.0 | 3.30 | 74 | 3.8 | 5.3 | 3,248 | 8.9 | 15.1 | 73.6 |
| Sweden | 82.0 | 2.73 | 61 | 3.6 | 10.8 | 3,432 | 8.9 | 13.6 | 81.4 |
| UK | 81.6 | 4.5 | 83 | 2.5 | 9.5 | 3,051 | 8.4 | 15.8 | 81.3 |
| US | 78.74 | 5.9 | 96 | 2.4 | 10.6 | 7,437 | 16.0 | 18.5 | 45.1 |
Physicians and hospital beds per 1000 inhabitants vs Health Care Spending in 2008 for OECD Countries. The data source is OECD.org - OECD.[47][48] Since 2008, the US experienced big deviations from 16% GDP. In 2010, the year the Affordable Care Act was enacted, health care spending accounted for approximately 17.2% of the U.S. GDP. By 2019, before the pandemic, it had risen to 17.7%. During the COVID-19 pandemic, this percentage jumped to 18.8% in 2020, largely due to increased health care costs and economic contraction. Post-pandemic, health care spending relative to GDP declined to 16.6% by 2022.[56][57]
| Professions | |
|---|---|
| Settings | |
| Care | |
| Skills / training | |
| Technology | |
| Health informatics |
|
| By country | |
| National | |
|---|---|
| Other | |
Health care, or healthcare, is the improvement or maintenance 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. The term includes work done in providing primary care, secondary care, tertiary care, and public health.
Access to health care may vary across countries, communities, and individuals, influenced by social and economic conditions and 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 health care access include financial limitations (such as insurance coverage), geographical and logistical barriers (such as additional transportation costs and the ability 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 affect negatively the use of medical services, the efficacy of treatments, and overall outcome (well-being, mortality rates).
Health systems are the organizations established to meet the health needs of targeted populations. According to the World Health Organization (WHO), 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.
An efficient health care system can contribute to a significant part of a country's economy, development, and industrialization. Health care is 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 health care interventions.[6]
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. These professionals systematically provide personal and population-based preventive, curative and rehabilitative care services.[citation needed]
While the definitions of the various types of health care vary based on the different cultural, political, organizational, and disciplinary perspectives, there is general consensus that primary care constitutes the first element of a continuous 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.[citation needed]
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. The primary care model supports first-contact, accessible, continuous, comprehensive and coordinated person-focused care.[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 such as a physician assistant or nurse practitioner. Depending on the locality and 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.[citation needed]
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.[citation needed]
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. 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.[citation needed]
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 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, such as psychiatrists, clinical psychologists, occupational therapists, most dental specialties or physiotherapists, do not necessarily work in hospitals. Some primary care services are delivered within 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.[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.[citation needed]
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.[citation needed]
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.[citation needed]
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]
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]
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.[citation needed]
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.[citation needed]
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.[citation needed]
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.[citation needed]
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.[24]
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:[citation needed]
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 health care access include financial limitations (such as insurance coverage), geographical and logistical barriers (such as additional transportation costs and the ability 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).[citation needed]
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.
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.[citation needed]
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[25] 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.[citation needed]
For example, pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States.[26][27] The United States dominates the biopharmaceutical field, accounting for three-quarters of the world's biotechnology revenues.[26][28]
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.[29]
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.[30] 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.[31]
There are generally five primary methods of funding health care systems:[32]
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 $1000 spent on health care, life expectancy falls by 0.4 years.[34] A similar correlation is seen from the analysis carried out each year by Bloomberg.[35] Clearly this kind of analysis is flawed in that life expectancy is only one measure of a health system's performance, but equally, the notion that more funding is better is not supported.[citation needed]
In the United States, the healthcare industry accounts for 18% of gross domestic product in 2020 and is one of the largest and most complex parts of the U.S. economy.[36] In 2011, the health care industry consumed an average of 9.3 percent of the GDP or US$ 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.[37][38] (see also international comparisons.)
In the United States, where around 18% of GDP is spent on health care,[35] the Commonwealth Fund analysis of spend and quality shows a clear correlation between worse quality and higher spending.[39]
Expand the OECD charts below to see the breakdown:
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.[41] Most countries have credentialing staff in regulatory boards or health departments who document the certification or licensing of health workers and their work history.[42]
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."[43]
Health information technology components:
Media related to Healthcare at Wikimedia Commons
Travel health travel guide from Wikivoyage| Professions | |
|---|---|
| Settings | |
| Care | |
| Skills / training | |
| Technology | |
| Health informatics |
|
| By country | |
| Levels of practice |
|
||||||||
|---|---|---|---|---|---|---|---|---|---|
| Education and licensure |
|||||||||
| Specialties and areas of practice |
|
||||||||
| Nursing process | |||||||||
| Classification systems |
|||||||||
| By country | |||||||||
| Specialties and subspecialties |
|
||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Medical education |
|||||||||||
| Related topics | |||||||||||
| National | |
|---|---|
| Other | |
Health care quality is a level of value provided by any health care resource, as determined by some measurement.[1] As with quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose. The goal of health care is to provide medical resources of high quality to all who need them; that is, to ensure good quality of life, cure illnesses when possible, to extend life expectancy, and so on. Researchers use a variety of quality measures to attempt to determine health care quality, including counts of a therapy's reduction or lessening of diseases identified by medical diagnosis, a decrease in the number of risk factors which people have following preventive care, or a survey of health indicators in a population who are accessing certain kinds of care.
Health care quality is the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes.[2] Quality of care plays an important role in describing the iron triangle of health care relationships between quality, cost, and accessibility of health care within a community.[3] Researchers measure health care quality to identify problems caused by overuse, underuse, or misuse of health resources.[4] In 1999, the Institute of Medicine released six domains to measure and describe quality of care in health:[5]
While essential for determining the effect of health services research interventions, measuring quality of care poses some challenges due to the limited number of outcomes that are measurable.[6] Structural measures describe the providers' ability to provide high quality care, process measures describe the actions taken to maintain or improve community health, and outcome measures describe the impact of a health care intervention.[6] Furthermore, due to strict regulations placed on health services research, data sources are not always complete.[7]
Assessment of health care quality may occur on two different levels: that of the individual patient and that of populations. At the level of the individual patient, or micro-level, assessment focuses on services at the point of delivery and its subsequent effects. At the population level, or macro-level, assessments of health care quality include indicators such as life expectancy, infant mortality rates, incidence, and prevalence of certain health conditions.[8] Quality assessments measure these indicators against an established standard. The measures can be difficult to define in health care.[9]
Doctor quality has been shown to reduce mortality and reduce cost per patient, while patient evaluations were found to not relate with doctor quality.[10]
Quality frameworks are essential tools for understanding and improving health systems. They help define, prioritize, and implement health system goals and functions. Among the key frameworks is the World Health Organization's building blocks model, which enhances health quality by focusing on elements like financing, workforce, information, medical products, governance, and service delivery. This model influences global health evaluation and contributes to indicator development and research.[11]
The Lancet Global Health Commission's 2018 framework builds upon earlier models by emphasizing system foundations, processes, and outcomes, guided by principles of efficiency, resilience, equity, and people-centeredness. This comprehensive approach addresses challenges associated with chronic and complex conditions and is particularly influential in health services research in developing countries.[12] Importantly, recent developments also highlight the need to integrate environmental sustainability into these frameworks, suggesting its inclusion as a guiding principle to enhance the environmental responsiveness of health systems.[13]
The Donabedian model is a common framework for assessing health care quality and identifies three domains in which health care quality can be assessed: structure, process, and outcomes.[14] All three domains are tightly linked and build on each other. Improvements in structure and process are often observed in outcomes. Some examples of improvements in process are: clinical practice guidelines, analysis of cost efficiency, and risk management, which consists of proactive steps to prevent medical errors.
Cost efficiency, or cost-effectiveness, determines whether the benefits of a service exceed the cost incurred to provide the service.[8] A health care service is sometimes not cost efficient due to either overutilization or underutilization. Overutilization, or overuse, occurs when the value of health care is diluted with wasted resources. Consequently, depriving someone else of the potential benefits from obtaining the service. Costs or risks of treatment outweigh the benefits in overused health care. In contrast, underutilization, or underuse, occurs when the benefits of a treatment outweigh the risks or costs, but it is not used.[8] There are potential adverse health outcomes with underutilization. One example is the lack of early cancer detection and treatment which leads to decreased cancer survival rates.
Clinical pathways are outcome-based and patient-centered case management tools that take on an interdisciplinary approach by "facilitating coordination of care among multiple clinical departments and caregivers".[8] Health care managers utilize clinical pathways as a method to reduce variation in care, decrease resource utilization, and improve quality of care.[15] Using clinical pathways to reduce costs and errors improves quality by providing a systematic approach to assessing health care outcomes. Reducing variations in practice patterns promotes improved collaboration among interdisciplinary players in the health care system.[8]
Research in care homes in England has shown that an organisation's staffing strategy can have an impact on the quality of care. More vacant positions in staff, for example, can lead to a worse rating by the Care Quality Commission (CQC). Also, better staff retention and improving work conditions can lead to higher quality care.[16][17]
The quality of the health care given by a health professional can be judged by its outcome, the technical performance of the care and by interpersonal relationships.[18]
"Outcome" is a change in patients' health, such as reduction in pain,[19] relapses,[20] or death rates.[21] Large differences in outcomes can be measured for individual medical providers, and smaller differences can be measured by studying large groups, such as low- and high-volume doctors.[22] Significant initiatives to improve healthcare quality outcomes have been undertaken that include clinical practice guidelines, cost efficiency, critical pathways, and risk management.[8]
"Technical performance" is the extent to which a health professional conformed to the best practices established by medical guidelines.[18] Clinical practice guidelines, or medical practice guidelines, are scientifically based protocols to assist providers in adopting a "best practice" approach in delivering care for a given health condition.[8] Standardizing the practice of medicine improves quality of care by concurrently promoting lower costs and better outcomes. The presumption is providers following medical guidelines are giving the best care and give the most hope of a good outcome.[18] Technical performance is judged from a quality perspective without regard to the actual outcome - so for example, if a physician gives care according to the guidelines but a patient's health does not improve, then by this measure, the quality of the "technical performance" is still high.[18] For example, a Cochrane review found that computer generated reminders improved doctors' adherence to guidelines and standard of care; but lacked evidence to determine whether or not this actually impacted patient centered health outcomes.[23]
Risk management consists of "proactive efforts to prevent adverse events related to clinical care" and is focused on avoiding medical malpractice.[8] Health care professionals are not immune to lawsuits; therefore, health care organizations have taken initiatives to establish protocols specifically to reduce malpractice litigation.[8] Malpractice concerns can result in defensive medicine, or threat of malpractice litigation, which can compromise patient safety and care by inducing additional testing or treatments. One widely used form of defensive medicine is ordering costly imaging which can be wasteful. However, other defensive behaviors may actually reduce access to care and pose risks of physical harm.[24] Many specialty physicians report doing more for patients, such as using unnecessary diagnostic tests, because of malpractice risks.[24] In turn, it is especially crucial that risk management approaches employ principles of cost efficiency with standardized practice guidelines and critical pathways.[8]
Patient satisfaction surveys are the main qualitative measure of the patient perspective. Patients may not have the clinical judgement of physicians and often judge quality on the basis of practitioner's concern and demeanor, among other things.[25] As a result, patient satisfaction surveys have become a somewhat controversial measure of quality care. Proponents argue that patient surveys can provide needed feedback to physicians to assist on improving their practice. In addition, patient satisfaction often correlates with patient involvement in decision making and can improve patient-centered care. Patients' evaluation of care can identify opportunities for improvement in care, reducing costs, monitoring performance of health plans, and provide a comparison across health care institutions.[26] Opponents of patient satisfaction surveys are often unconvinced that the data is reliable, that the expense does not justify the costs, and that what is measured is not a good indicator of quality.[27]
The Department of Health and Human Services bases 30 percent of hospitals' Medicare reimbursement on patient satisfaction survey scores on a survey, known as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).[28] "Beginning in October 2012, the Affordable Care Act implemented a policy that withholds 1 percent of total Medicare reimbursements—approximately $850 million—from hospitals (that percentage will double in 2017). Each year, only hospitals with high patient-satisfaction scores and a measure of certain basic care standards will earn that money back, and top performers receive bonuses from the pool."[29]
Measuring the quality of care is not always straightforward. For example there are cases where people have difficulties with self-report such as the most dependent care home residents. At the same time their views would be necessary for improving the well-being of the residents. A mixed-methods approach to assessment can help prevent their exclusion from surveys.[17]
Technology also may affect patients' perception of health care quality.[30] A 2015 survey of cancer patients shows that those who have a more positive attitude towards the health information tools from their providers use the tools more and subsequently have a higher perceived care quality from their provider. The same survey also shows that those who believe their provider acts more securely and have a lower level of privacy concern are more likely to have a positive attitude towards the health information tools from their providers and thus a higher perception of the care they received.
Organizations which work to set standards and measures for health care quality include Government health systems; private health systems, accreditation programs such as those for hospital accreditation, health associations, or those who wish to establish international healthcare accreditation; philanthropic foundations; and health research institutions.[31] These organizations seek to define the concept of quality in healthcare, measure that quality, and then encourage the regular measurement of quality so as to provide evidence that health interventions are effective.[31]
Multiple organizations have established measures to define quality since providers, patients, and payers have different views and expectations of quality.[32] This complex situation creates a challenge because most often the measures of quality are not comparable across organizations and there are issues of transferability and merging across systems.[8] Consequently, while measuring health care quality for these reasons, high quality longitudinal provides a substantive framework from which health services researchers can work.
The Centers for Medicare and Medicaid Services (CMS) designs quality evaluations, collects quality, and manages funding for the central government Medicare and Medicaid programs.[33] In 2001, CMS started multiple quality initiatives including, but not limited to: the Home Health Quality Initiative, the Hospital Value-based Purchasing Program, the Hospice Quality Reporting Program, the Inpatient Rehabilitation Facilities Quality Reporting, and the Long-Term Care Hospitals Quality Reporting.[34] CMS established initiatives to measure and improve the quality of care for Medicaid and CHIP beneficiaries for services provided under the umbrella of Early Periodic Screening, Diagnosis, and Treatment Program (EPSDT), including maternal and infant health, home and community-based services, preventative care, health disparities, patient safety, external quality review, and improving care transitions.[33] For broader quality control, CMS also created Hospital Compare, which is a large public reporting program that measures and also reports processes of care and outcomes for various health care interventions including heart failure, pneumonia, and acute myocardial infarction.[35]
The Agency for Healthcare Research and Quality (AHRQ) is a central government organization which collects public reports of health quality evaluation to increase the safety and quality of health care. AHRQ works together with the United States Department of Health and Human Services to make ensure that evidence is understood and used by the medical communities to elevate the quality of care.[36] To fulfill its mission, AHRQ contracts with several subsites.
CMS and AHRQ have collectively established the Hospital Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. The CAHPS survey collects uniform measures of patients' perspectives on various aspects of the care they receive in inpatient settings.[37] The results are published on the Hospital Compare website, which may be used by health care organizations and researchers to improve the quality of their services. Purchasers, consumers, and researchers may also use the data to make informed business choices.
The Joint Commission Accreditation for Healthcare Organization (JCAHO) is a nonprofit organization that assesses quality at multiple levels by inspecting health care facilities for adherence to clinical guidelines, compliance with rules and regulations for medical staff skills and qualifications, review of medical records to evaluate care processes and search for medical errors, and inspects buildings for safety code violations. JCAHO also provides feedback and opportunities for improvement, while simultaneously issuing citations for closures of facilities deemed noncompliant with set measures of quality standards.[38] howdy
In the UK, healthcare is publicly funded and delivered through the National Health Service (NHS) and quality is overseen by a number of different bodies.[39] Monitor, a non-departmental public body sponsored by the Department of Health, is the sector regulator for health services in England. It works closely with the Care Quality Commission (CQC) a government-funded independent body responsible for overseeing the quality and safety of health and social care services in England, including hospitals, care homes, dental and GPs and other care services. The National Institute for Health and Care Research (NIHR) has a number of infrastructure programmes supporting quality in healthcare, including the Collaborations for Leadership in Applied Health Research and Care (CLAHRCs).[40]
Medical professions in the UK have their own membership and regulatory associations. These include the General Medical Council (GMC), the Nursing and Midwifery Council, the General Dental Council and the Health and Care Professions Council. Other healthcare quality organisations include the Healthcare Quality Improvement Partnership (HQIP), a charity and limited company established by the Academy of Medical Royal Colleges, the Royal College of Nursing, National Voices; and Healthwatch, a statutory national body that works with groups across the country to ensure that patients' views are at the heart of decisions about the healthcare system.
A number of health think tanks, including the King's Fund, the Nuffield Trust and the Health Foundation offer analysis, resources and commentary around healthcare quality. In 2013, the Nuffield Trust and the Health Foundation launched QualityWatch, an independent research programme tracking how healthcare quality in England is changing in response to rising remand and limited funding.[41]
The Health and Care Act was passed in England in 2022 to improve health, well-being and services especially by strengthening the integration of the different tiers of health services and between health and social care, historically separately organised and delivered. The chief mechanism for change was the formal establishment of forty two integrated care systems to cover England. The NIHR Quality, Safety and Outcomes Policy Research Unit has focused on measuring and assessing the integration of services. They began by examining whether measures were available to assess processes and outcomes of integration of services. They found a very large number of available measures but the infrequent use of any common set of measures made comparisons between systems very difficult. They concluded that the promotion of a core measurement set for assessing system integration would advance assessment of quality of services.[42] At the same time the QSO Research Unit carried out a consultation with professionals and the public involved in the English Health and Care System to establish how they would ideally assess quality and integration of services. There was a consensus that the quality of integration of services was best assessed from patients' and users' perspectives and that currently there was a dearth of evidence of patient perceived benefits to inform the development of services.[43]
The QSO Unit is also assessing how well newly established integrated care system can promote quality of services across health and social care.[44]
In Scotland the Scottish Quality and Safety Fellowship (SQSF), a quality improvement programme was established by the NHS Scotland. The 10-month long programme focuses on leadership skills and the principles and values of quality improvement. According to an evaluation the SQSF resulted in significant positive outcomes for most participants.[45]
Healthcare quality efforts in India are beginning to gain strength. Some organizations involved in this work include the National Accreditation Board for Hospital & Healthcare providers (NABH), Patient Safety Alliance, ICHA and National Health Systems Resource Center (NHSRC). The All India Institute of Medical Sciences is also leading some of the healthcare quality work in India and in the SEARO region.
As early as the 19th century, healthcare quality improvement interventions were implemented in an effort to improve healthcare outcomes.[46] Healthcare quality improvement further developed in the 1900s, with notable improvements for the modern field of quality improvement taking place in the late 1960s.
In the early 1900s, Dr. Ernest Codman of Massachusetts General Hospital suggested a measure that tracked each patient of the hospital to determine effectiveness of their treatment. His proposal of a system to track patient care to determine quality and standard of hospital care dubbed him one of the earliest advocates of healthcare quality.[47] Shortly after, influenced by the work of Dr. Codman, the American College of Surgeons (ACS) was founded. In 1918, the ACS developed the Minimum Standard for Hospitals, which was one page. As a result of the 1918 Minimum Standard for Hospitals, ACS began performing on-site inspections of hospitals to determine if they were up to par. During the first on-site inspections of 692 hospitals, only 13% met the minimum standard.[47]
In 1945, Joseph Juran and Edwards Deming established Quality Improvement (QI) as a formal approach to analyzing systematic efforts to improve performance.[47] Specifically, Deming, a philosopher, placed emphasis on the macro level of organizational management and improvement via a systems approach. Juran, on the other hand, strategized quality planning, control, and improvement at the micro level. He encouraged questions, believing they deepened understanding of problems and led to increased effectiveness in planning and taking action. Together, their work influenced quality of both American public and private organizations in fields from healthcare and industry to government and education.
The Joint Commission on Accreditation of Hospitals (JCAH) was established in 1951 as an independent and non-profit organization that provided voluntary accreditation to hospitals that met minimum quality standards.[48] JCAH was formed by the combined forces of the American College of Physicians, the American College of Surgeons, the American Hospital Association, the American Medical Association, and the Canadian Medical Association. In 1952, the ACS formally transferred its Hospital Standardization Program to JCAH. JCAH began to charge a fee for surveys in 1964.
The Social Security Amendments of 1965 were passed by Congress in an attempt to grant hospitals accredited by JCAH "deemed status". As such, those same hospitals were said to meet the necessary requirements to participate in Medicare and Medicaid.[48] Until 1966, when Avedis Donabedian, MD published his "Evaluating the Quality of Medical Care", the study of health care quality was based on structure (e.g., licensing, staffing levels, accreditation). Donabedian demonstrated a new perspective on analyzing healthcare quality that was based on structure, process, and outcome.[47]
The National Academy of Sciences established the Institute of Medicine (IOM) in 1970. The IOM, a non-profit and independent scientific advisor, was created to improve health on a national scale. The Accreditation Association for Ambulatory Health Care (AAAHC) formed in 1970 to improve healthcare quality for patients served by ambulatory health care organizations by setting standards for ambulatory healthcare accreditation, similar to JCAH. The Agency for Healthcare Research and Quality (AHRQ) was created in 1989 in order to improve quality, safety, efficiency, and effectiveness of health care through research.
In 1990, the National Committee for Quality Assurance (NCQA) was entrusted to offer accreditation programs for managed care organizations. The NCQA was established as an independent non-profit dedicated to improving health care quality through accreditation and performance measurement.[49] In 1991, Dr. Don Berwick's non-profit Institute for Healthcare Improvement (IHI) was founded. Rather than only focus on national health care quality improvement, IHI campaigned but nationally and worldwide. Directing the focus onto the patient as a consumer, the National Patient Safety Foundation was established in 1996. In 1998, by presidential directive, the Quality Interagency Coordination Task Force (QuIC) was created to increase coordination of federal agencies that work toward improving quality care.[47] When the IOM published To Err is Human in 1999, revealing high medical error mortality rates, the QuIC published a report that inventoried regulatory and legislative initiatives that sought to improve issues surrounding medical error. Also in 1999, the National Quality Forum was founded. The private, non-profit forum aims to standardize health care delivery and measurements of quality.[50] In response to the patient safety concerns discussed in To Err is Human, the United States enacted the Patient Safety and Quality Improvement Act in 2005.
More recently, the focus of quality improvement has been emerging health information technology (e.g., electronic health records and patient-centered care.[citation needed] As a result, the formation of Patient-Centered Medical Homes (PCMH) began to gain popularity in 2007. Under PCMH, care among personal primary care physicians and specialists increased coordination and integration of care for the patient. Furthermore, technology was used to maintain personal health information and enhance quality and safety. Since 2007, various studies have demonstrated the wide array of benefits of PCMHs in healthcare quality improvement.[citation needed]
Health has a variety of definitions, which have been used for different purposes over time. In general, it refers to physical and emotional well-being, especially that associated with normal functioning of the human body, absent of disease, pain (including mental pain), or injury.
Health can be promoted by encouraging healthful activities, such as regular physical exercise and adequate sleep,[1] and by reducing or avoiding unhealthful activities or situations, such as smoking or excessive stress. Some factors affecting health are due to individual choices, such as whether to engage in a high-risk behavior, while others are due to structural causes, such as whether the society is arranged in a way that makes it easier or harder for people to get necessary healthcare services. Still, other factors are beyond both individual and group choices, such as genetic disorders.
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
The meaning of health has evolved over time. In keeping with the biomedical perspective, early definitions of health focused on the theme of the body's ability to function; health was seen as a state of normal function that could be disrupted from time to time by disease. An example of such a definition of health is: "a state characterized by anatomic, physiologic, and psychological integrity; ability to perform personally valued family, work, and community roles; ability to deal with physical, biological, psychological, and social stress".[2] Then, in 1948, in a radical departure from previous definitions, the World Health Organization (WHO) proposed a definition that aimed higher, linking health to well-being, in terms of "physical, mental, and social well-being, and not merely the absence of disease and infirmity".[3] Although this definition was welcomed by some as being innovative, it was also criticized for being vague and excessively broad and was not construed as measurable. For a long time, it was set aside as an impractical ideal, with most discussions of health returning to the practicality of the biomedical model.[4]
Just as there was a shift from viewing disease as a state to thinking of it as a process, the same shift happened in definitions of health. Again, the WHO played a leading role when it fostered the development of the health promotion movement in the 1980s. This brought in a new conception of health, not as a state, but in dynamic terms of resiliency, in other words, as "a resource for living". In 1984, WHO revised the definition of health defined it as "the extent to which an individual or group is able to realize aspirations and satisfy needs and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities."[5] Thus, health referred to the ability to maintain homeostasis and recover from adverse events. Mental, intellectual, emotional and social health referred to a person's ability to handle stress, to acquire skills, to maintain relationships, all of which form resources for resiliency and independent living.[4] This opens up many possibilities for health to be taught, strengthened and learned.
Since the late 1970s, the federal Healthy People Program has been a visible component of the United States' approach to improving population health.[6] In each decade, a new version of Healthy People is issued,[7] featuring updated goals and identifying topic areas and quantifiable objectives for health improvement during the succeeding ten years, with assessment at that point of progress or lack thereof. Progress has been limited to many objectives, leading to concerns about the effectiveness of Healthy People in shaping outcomes in the context of a decentralized and uncoordinated US health system. Healthy People 2020 gives more prominence to health promotion and preventive approaches and adds a substantive focus on the importance of addressing social determinants of health. A new expanded digital interface facilitates use and dissemination rather than bulky printed books as produced in the past. The impact of these changes to Healthy People will be determined in the coming years.[8]
Systematic activities to prevent or cure health problems and promote good health in humans are undertaken by health care providers. Applications with regard to animal health are covered by the veterinary sciences. The term "healthy" is also widely used in the context of many types of non-living organizations and their impacts for the benefit of humans, such as in the sense of healthy communities, healthy cities or healthy environments. In addition to health care interventions and a person's surroundings, a number of other factors are known to influence the health status of individuals. These are referred to as the "determinants of health", which include the individual's background, lifestyle, economic status, social conditions and spirituality; Studies have shown that high levels of stress can affect human health.[9]
In the first decade of the 21st century, the conceptualization of health as an ability opened the door for self-assessments to become the main indicators to judge the performance of efforts aimed at improving human health.[10] It also created the opportunity for every person to feel healthy, even in the presence of multiple chronic diseases or a terminal condition, and for the re-examination of determinants of health (away from the traditional approach that focuses on the reduction of the prevalence of diseases).[11]
In general, the context in which an individual lives is of great importance for both his health status and quality of life. It is increasingly recognized that health is maintained and improved not only through the advancement and application of health science, but also through the efforts and intelligent lifestyle choices of the individual and society. According to the World Health Organization, the main determinants of health include the social and economic environment, the physical environment, and the person's individual characteristics and behaviors.[12][dead link]
More specifically, key factors that have been found to influence whether people are healthy or unhealthy include the following:[12][13][14]
|
|
An increasing number of studies and reports from different organizations and contexts examine the linkages between health and different factors, including lifestyles, environments, health care organization and health policy, one specific health policy brought into many countries in recent years was the introduction of the sugar tax. Beverage taxes came into light with increasing concerns about obesity, particularly among youth. Sugar-sweetened beverages have become a target of anti-obesity initiatives with increasing evidence of their link to obesity.[15]—such as the 1974 Lalonde report from Canada;[14] the Alameda County Study in California;[16] and the series of World Health Reports of the World Health Organization, which focuses on global health issues including access to health care and improving public health outcomes, especially in developing countries.[17]
The concept of the "health field," as distinct from medical care, emerged from the Lalonde report from Canada. The report identified three interdependent fields as key determinants of an individual's health. These are:[14]
The maintenance and promotion of health is achieved through different combination of physical, mental, and social well-being—a combination sometimes referred to as the "health triangle."[18] The WHO's 1986 Ottawa Charter for Health Promotion further stated that health is not just a state, but also "a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities."[19]
Focusing more on lifestyle issues and their relationships with functional health, data from the Alameda County Study suggested that people can improve their health via exercise, enough sleep, spending time in nature, maintaining a healthy body weight, limiting alcohol use, and avoiding smoking.[20] Health and illness can co-exist, as even people with multiple chronic diseases or terminal illnesses can consider themselves healthy.[21]
If you want to learn about the health of a population, look at the air they breathe, the water they drink, and the places where they live.[22][23]
— Hippocrates, the Father of Medicine, 5th century BC
The environment is often cited as an important factor influencing the health status of individuals. This includes characteristics of the natural environment, the built environment and the social environment. Factors such as clean water and air, adequate housing, and safe communities and roads all have been found to contribute to good health, especially to the health of infants and children.[12][24] Some studies have shown that a lack of neighborhood recreational spaces including natural environment leads to lower levels of personal satisfaction and higher levels of obesity, linked to lower overall health and well-being.[25] It has been demonstrated that increased time spent in natural environments is associated with improved self-reported health,[26] suggesting that the positive health benefits of natural space in urban neighborhoods should be taken into account in public policy and land use.
Genetics, or inherited traits from parents, also play a role in determining the health status of individuals and populations. This can encompass both the predisposition to certain diseases and health conditions, as well as the habits and behaviors individuals develop through the lifestyle of their families. For example, genetics may play a role in the manner in which people cope with stress, either mental, emotional or physical. For example, obesity is a significant problem in the United States that contributes to poor mental health and causes stress in the lives of many people.[27] One difficulty is the issue raised by the debate over the relative strengths of genetics and other factors; interactions between genetics and environment may be of particular importance.
A number of health issues are common around the globe. Disease is one of the most common. According to GlobalIssues.org, approximately 36 million people die each year from non-communicable (i.e., not contagious) diseases, including cardiovascular disease, cancer, diabetes and chronic lung disease.[28]
Among communicable diseases, both viral and bacterial, AIDS/HIV, tuberculosis, and malaria are the most common, causing millions of deaths every year.[28]
Another health issue that causes death or contributes to other health problems is malnutrition, especially among children. One of the groups malnutrition affects most is young children. Approximately 7.5 million children under the age of 5 die from malnutrition, usually brought on by not having the money to find or make food.[28]
Bodily injuries are also a common health issue worldwide. These injuries, including bone fractures and burns, can reduce a person's quality of life or can cause fatalities including infections that resulted from the injury (or the severity injury in general).[28]
Lifestyle choices are contributing factors to poor health in many cases. These include smoking cigarettes, and can also include a poor diet, whether it is overeating or an overly constrictive diet. Inactivity can also contribute to health issues and also a lack of sleep, excessive alcohol consumption, and neglect of oral hygiene.[citation needed] There are also genetic disorders that are inherited by the person and can vary in how much they affect the person (and when they surface).[29][30]
Although the majority of these health issues are preventable, a major contributor to global ill health is the fact that approximately 1 billion people lack access to health care systems.[28] Arguably, the most common and harmful health issue is that a great many people do not have access to quality remedies.[31]
The World Health Organization describes mental health as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community".[32] Mental health is not just the absence of mental illness.[33]
Mental illness is described as 'the spectrum of cognitive, emotional, and behavioral conditions that interfere with social and emotional well-being and the lives and productivity of people.[34] Having a mental illness can seriously impair, temporarily or permanently, the mental functioning of a person. Other terms include: 'mental health problem', 'illness', 'disorder', 'dysfunction'.[35]
Approximately twenty percent of all adults in the US are considered diagnosable with a mental disorder. Mental disorders are the leading cause of disability in the United States and Canada. Examples of these disorders include schizophrenia, ADHD, major depressive disorder, bipolar disorder, anxiety disorder, post-traumatic stress disorder and autism.[36]
Many factors contribute to mental health problems, including:[37]
Achieving and maintaining health is an ongoing process, shaped by both the evolution of health care knowledge and practices as well as personal strategies and organized interventions for staying healthy.
An important way to maintain one's personal health is to have a healthy diet. A healthy diet includes a variety of plant-based and animal-based foods that provide nutrients to the body.[41] Such nutrients provide the body with energy and keep it running. Nutrients help build and strengthen bones, muscles, and tendons and also regulate body processes (i.e., blood pressure). Water is essential for growth, reproduction and good health. Macronutrients are consumed in relatively large quantities and include proteins, carbohydrates, and fats and fatty acids.[42] Micronutrients – vitamins and minerals – are consumed in relatively smaller quantities, but are essential to body processes.[43] The food guide pyramid is a pyramid-shaped guide of healthy foods divided into sections. Each section shows the recommended intake for each food group (i.e., protein, fat, carbohydrates and sugars). Making healthy food choices can lower one's risk of heart disease and the risk of developing some types of cancer, and can help one maintain their weight within a healthy range.[44]
The Mediterranean diet is commonly associated with health-promoting effects. This is sometimes attributed to the inclusion of bioactive compounds such as phenolic compounds, isoprenoids and alkaloids.[45]
Physical exercise enhances or maintains physical fitness and overall health and wellness. It strengthens one's bones and muscles and improves the cardiovascular system. According to the National Institutes of Health, there are four types of exercise: endurance, strength, flexibility, and balance.[46] The CDC states that physical exercise can reduce the risks of heart disease, cancer, type 2 diabetes, high blood pressure, obesity, depression, and anxiety.[47] For the purpose of counteracting possible risks, it is often recommended to start physical exercise gradually as one goes. Participating in any exercising, whether it is housework, yardwork, walking or standing up when talking on the phone, is often thought to be better than none when it comes to health.[48]
Sleep is an essential component to maintaining health. In children, sleep is also vital for growth and development. Ongoing sleep deprivation has been linked to an increased risk for some chronic health problems. In addition, sleep deprivation has been shown to correlate with both increased susceptibility to illness and slower recovery times from illness.[49] In one study, people with chronic insufficient sleep, set as six hours of sleep a night or less, were found to be four times more likely to catch a cold compared to those who reported sleeping for seven hours or more a night.[50] Due to the role of sleep in regulating metabolism, insufficient sleep may also play a role in weight gain or, conversely, in impeding weight loss.[51] Additionally, in 2007, the International Agency for Research on Cancer, which is the cancer research agency for the World Health Organization, declared that "shiftwork that involves circadian disruption is probably carcinogenic to humans", speaking to the dangers of long-term nighttime work due to its intrusion on sleep.[52] In 2015, the National Sleep Foundation released updated recommendations for sleep duration requirements based on age, and concluded that "Individuals who habitually sleep outside the normal range may be exhibiting signs or symptoms of serious health problems or, if done volitionally, may be compromising their health and well-being."[53]
| Age and condition | Sleep needs |
|---|---|
| Newborns (0–3 months) | 14 to 17 hours |
| Infants (4–11 months) | 12 to 15 hours |
| Toddlers (1–2 years) | 11 to 14 hours |
| Preschoolers (3–5 years) | 10 to 13 hours |
| School-age children (6–13 years) | 9 to 11 hours |
| Teenagers (14–17 years) | 8 to 10 hours |
| Adults (18–64 years) | 7 to 9 hours |
| Older Adults (65 years and over) | 7 to 8 hours |
Health science is the branch of science focused on health. There are two main approaches to health science: the study and research of the body and health-related issues to understand how humans (and animals) function, and the application of that knowledge to improve health and to prevent and cure diseases and other physical and mental impairments. The science builds on many sub-fields, including biology, biochemistry, physics, epidemiology, pharmacology, medical sociology. Applied health sciences endeavor to better understand and improve human health through applications in areas such as health education, biomedical engineering, biotechnology and public health.[citation needed]
Organized interventions to improve health based on the principles and procedures developed through the health sciences are provided by practitioners trained in medicine, nursing, nutrition, pharmacy, social work, psychology, occupational therapy, physical therapy and other health care professions. Clinical practitioners focus mainly on the health of individuals, while public health practitioners consider the overall health of communities and populations. Workplace wellness programs are increasingly being adopted by companies for their value in improving the health and well-being of their employees, as are school health services to improve the health and well-being of children.[citation needed]
Contemporary medicine is in general conducted within health care systems. Legal, credentialing and financing frameworks are established by individual governments, augmented on occasion by international organizations, such as churches. The characteristics of any given health care system have significant impact on the way medical care is provided.
From ancient times, Christian emphasis on practical charity gave rise to the development of systematic nursing and hospitals and the Catholic Church today remains the largest non-government provider of medical services in the world.[54] Advanced industrial countries (with the exception of the United States)[55] and many developing countries provide medical services through a system of universal health care that aims to guarantee care for all through a single-payer health care system, or compulsory private or co-operative health insurance. This is intended to ensure that the entire population has access to medical care on the basis of need rather than ability to pay. Delivery may be via private medical practices or by state-owned hospitals and clinics, or by charities, most commonly by a combination of all three.
Most tribal societies provide no guarantee of healthcare for the population as a whole.[56] In such societies, healthcare is available to those that can afford to pay for it or have self-insured it (either directly or as part of an employment contract) or who may be covered by care financed by the government or tribe directly.
Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality, and pricing greatly affects the choice by patients/consumers and, therefore, the incentives of medical professionals. While the US healthcare system has come under fire for lack of openness,[57] new legislation may encourage greater openness. There is a perceived tension between the need for transparency on the one hand and such issues as patient confidentiality and the possible exploitation of information for commercial gain on the other.
Provision of medical care is classified into primary, secondary, and tertiary care categories.[58]
Primary care medical services are provided by physicians, physician assistants, nurse practitioners, or other health professionals who have first contact with a patient seeking medical treatment or care.[59] These occur in physician offices, clinics, nursing homes, schools, home visits, and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses, preventive care and health education for all ages and both sexes.
Secondary care medical services are provided by medical specialists in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient.[60] Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both ambulatory care and inpatient services, Emergency departments, intensive care medicine, surgery services, physical therapy, labor and delivery, endoscopy units, diagnostic laboratory and medical imaging services, hospice centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting.
Tertiary care medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include trauma centers, burn treatment centers, advanced neonatology unit services, organ transplants, high-risk pregnancy, radiation oncology, etc.
Modern medical care also depends on information – still delivered in many health care settings on paper records, but increasingly nowadays by electronic means.
In low-income countries, modern healthcare is often too expensive for the average person. International healthcare policy researchers have advocated that "user fees" be removed in these areas to ensure access, although even after removal, significant costs and barriers remain.[61]
Separation of prescribing and dispensing is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from the pharmacist who provides the prescription drug. In the Western world there are centuries of tradition for separating pharmacists from physicians. In Asian countries, it is traditional for physicians to also provide drugs.[62]
Public health has been described as "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals."[63] It is concerned with threats to the overall health of a community based on population health analysis. The population in question can be as small as a handful of people or as large as all the inhabitants of several continents (for instance, in the case of a pandemic). Public health has many sub-fields, but typically includes the interdisciplinary categories of epidemiology, biostatistics and health services. environmental health, community health, behavioral health, and occupational health are also important areas of public health.
The focus of public health interventions is to prevent and manage diseases, injuries and other health conditions through surveillance of cases and the promotion of healthy behavior, communities, and (in aspects relevant to human health) environments. Its aim is to prevent health problems from happening or re-occurring by implementing educational programs, developing policies, administering services and conducting research.[64] In many cases, treating a disease or controlling a pathogen can be vital to preventing it in others, such as during an outbreak. Vaccination programs and distribution of condoms to prevent the spread of communicable diseases are examples of common preventive public health measures, as are educational campaigns to promote vaccination and the use of condoms (including overcoming resistance to such).
Public health also takes various actions to limit the health disparities between different areas of the country and, in some cases, the continent or world. One issue is the access of individuals and communities to health care in terms of financial, geographical or socio-cultural constraints.[65] Applications of the public health system include the areas of maternal and child health, health services administration, emergency response, and prevention and control of infectious and chronic diseases.
The great positive impact of public health programs is widely acknowledged. Due in part to the policies and actions developed through public health, the 20th century registered a decrease in the mortality rates for infants and children and a continual increase in life expectancy in most parts of the world. For example, it is estimated that life expectancy has increased for Americans by thirty years since 1900,[66] and worldwide by six years since 1990.[67]
Personal health depends partially on the active, passive, and assisted cues people observe and adopt about their own health. These include personal actions for preventing or minimizing the effects of a disease, usually a chronic condition, through integrative care. They also include personal hygiene practices to prevent infection and illness, such as bathing and washing hands with soap; brushing and flossing teeth; storing, preparing and handling food safely; and many others. The information gleaned from personal observations of daily living – such as about sleep patterns, exercise behavior, nutritional intake and environmental features – may be used to inform personal decisions and actions (e.g., "I feel tired in the morning so I am going to try sleeping on a different pillow"), as well as clinical decisions and treatment plans (e.g., a patient who notices his or her shoes are tighter than usual may be having exacerbation of left-sided heart failure, and may require diuretic medication to reduce fluid overload).[68]
Personal health also depends partially on the social structure of a person's life. The maintenance of strong social relationships, volunteering, and other social activities have been linked to positive mental health and also increased longevity. One American study among seniors over age 70, found that frequent volunteering was associated with reduced risk of dying compared with older persons who did not volunteer, regardless of physical health status.[69] Another study from Singapore reported that volunteering retirees had significantly better cognitive performance scores, fewer depressive symptoms, and better mental well-being and life satisfaction than non-volunteering retirees.[70]
Prolonged psychological stress may negatively impact health, and has been cited as a factor in cognitive impairment with aging, depressive illness, and expression of disease.[71] Stress management is the application of methods to either reduce stress or increase tolerance to stress. Relaxation techniques are physical methods used to relieve stress. Psychological methods include cognitive therapy, meditation, and positive thinking, which work by reducing response to stress. Improving relevant skills, such as problem solving and time management skills, reduces uncertainty and builds confidence, which also reduces the reaction to stress-causing situations where those skills are applicable.
In addition to safety risks, many jobs also present risks of disease, illness and other long-term health problems. Among the most common occupational diseases are various forms of pneumoconiosis, including silicosis and coal worker's pneumoconiosis (black lung disease). Asthma is another respiratory illness that many workers are vulnerable to. Workers may also be vulnerable to skin diseases, including eczema, dermatitis, urticaria, sunburn, and skin cancer.[72] Other occupational diseases of concern include carpal tunnel syndrome and lead poisoning.
As the number of service sector jobs has risen in developed countries, more and more jobs have become sedentary, presenting a different array of health problems than those associated with manufacturing and the primary sector. Contemporary problems, such as the growing rate of obesity and issues relating to stress and overwork in many countries, have further complicated the interaction between work and health.
Many governments view occupational health as a social challenge and have formed public organizations to ensure the health and safety of workers. Examples of these include the British Health and Safety Executive and in the United States, the National Institute for Occupational Safety and Health, which conducts research on occupational health and safety, and the Occupational Safety and Health Administration, which handles regulation and policy relating to worker safety and health.[73]
cite book: ISBN / Date incompatibility (help)
Media related to Health at Wikimedia Commons| International | |
|---|---|
| National | |
| Other | |
Health care, healthcare or medical care is the diagnosis, treatment, and prevention of disease, illness, and injury.
Health care may also refer to:
