Articles Fact

Tuesday, October 6, 2015

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 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 nations. Implicitly, nations must design and develop health systems in accordance with their needs and resources, although common elements in virtually all health systems are primary health care and public health measures. In some countries, health system planning is distributed among market participants. In others, there is a concerted effort among governments, trade unions, charities, religious organizations, or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has been described as often evolutionary rather than revolutionary.

Goals

The World Health Organization (WHO), the directing and coordinating authority for health within the United Nations system, is promoting a goal of universal health care: to ensure that all people obtain the health services they need without suffering financial hardship when paying for them. According to WHO, health care 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. Other dimensions for the evaluation of health systems include quality, efficiency, acceptability, and equity. They have also been described in the United States as "the five C's": Cost, Coverage, Consistency, Complexity, and Chronic Illness. Also, continuity of health care is a major goal.

Definitions

Often health system has been defined with a reductionist perspective, for example reducing it to health care system. In many publications, for example, both expressions are used interchangeably. Some authors have developed arguments to expand the concept of health systems, indicating additional dimensions that should be considered:

Health systems should not be expressed in terms of their components only, but also of their interrelationships;
Health systems should include not only the institutional or supply side of the health system, but also the population;
Health systems must be seen in terms of their goals, which include not only health improvement, but also equity, responsiveness to legitimate expectations, respect of dignity, and fair financing, among others;
Health systems must also be defined in terms of their functions, including the direct provision of services, whether they are medical or public health services, but also "other enabling functions, such as stewardship, financing, and resource generation, including what is probably the most complex of all challenges, the health workforce."

World Health Organization definition

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.

Providers

Health care providers are institutions or individuals providing health care services. Individuals including health professionals and allied health professions can be self-employed or working as an employee in a hospital, clinic, or other health care institution, whether government operated, private for-profit, or private not-for-profit (e.g. non-governmental organization). They may also work outside of direct patient care such as in a government health department or other agency, medical laboratory, or health training institution. Examples of health workers are doctors, nurses, midwives, dietitians, paramedics, dentists, medical laboratory technologists, therapists, psychologists, pharmacists, chiropractors, optometrists, community health workers, traditional medicine practitioners, and others.

Financial resources

There are generally five primary methods of funding health systems:

general taxation to the state, county or municipality
social health insurance
voluntary or private health insurance
out-of-pocket payments
donations to charities
Most countries' systems feature a mix of all five models. One study 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.

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.

By estimating the overall cost of health care expenses, a routine finance structure (such as a monthly premium or annual tax) can be developed, ensuring that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is typically administered by a government agency, a non-profit health fund or a corporation operating seeking to make a profit.

Many forms of commercial health insurance control their costs by restricting the benefits that are paid by through deductibles, co-payments, coinsurance, policy exclusions, and total coverage limits and will severely restrict or refuse coverage of pre-existing conditions. Many government schemes also have co-payment schemes but exclusions are rare because of political pressure. The larger insurance schemes may also negotiate fees with providers.

Many forms of social insurance schemes control their costs by using the bargaining power of their community they represent to control costs in the health care delivery system. For example, by negotiating drug prices directly with pharmaceutical companies negotiating standard fees with the medical profession, or reducing unnecessary health care costs. Social schemes sometimes feature contributions related to earnings as part of a scheme to deliver universal health care, which may or may not also involve the use of commercial and non-commercial insurers. Essentially the more wealthy pay proportionately more into the scheme to cover the needs of the relatively poor 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).

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, 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.

Capitation

In capitation payment systems, GPs are paid for each patient on their "list", usually with adjustments for factors such as age and gender. According to OECD, "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."

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."

Salary arrangements

In several OECD countries, general practitioners (GPs) are employed on salaries for the government.[16] 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." There has been movement away from this system.

Information resources

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 health care – 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 data processed may include patients' medical records, hospital administration and clinical functions, and human resources information.

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.

Management

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 health care delivery and financing, pharmaceuticals, health human resources, and public health.

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.

A child being immunized against polio.

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.

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 health care delivery practices. An important health issue facing the world currently is HIV/AIDS. Another major public health concern is diabetes. In 2006, according to the World Health Organization, at least 171 million people worldwide suffered from diabetes. Its incidence is increasing rapidly, and it is estimated that by the year 2030, this number will double. A controversial aspect of public health is the control of tobacco smoking, linked to cancer and other chronic illnesses.

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, is calling for intensified global commitment to safeguard antibiotics and other antimicrobial medicines for future generations.

Health systems performance

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 progresses 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 performances. Like most social systems, health systems are complex adaptive systems where change does not necessarily follow rigid epidemiological models. In complex systems path dependency, emergent properties and other non-linear patterns are under-explored and unmeasured, which can lead to the development of inappropriate guidelines for developing responsive health systems

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[26] including human resources development 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.

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. 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. 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.

Health system

Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses, among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity. According to the Health Insurance Association of America, health insurance is defined as "coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment" .

A health insurance policy is:

A contract between an insurance provider (e.g. an insurance company or a government) and an individual or his/her sponsor (e.g. an employer or a community organization). The contract can be renewable (e.g. annually, monthly) or lifelong in the case of private insurance, or be mandatory for all citizens in the case of national plans. The type and amount of health care costs that will be covered by the health insurance provider are specified in writing, in a member contract or "Evidence of Coverage" booklet for private insurance, or in a national health policy for public insurance.
Provided by an employer-sponsored self-funded ERISA plan. The company generally advertises that they have one of the big insurance companies. However, in an ERISA case, that insurance company "doesn't engage in the act of insurance", they just administer it. Therefore, ERISA plans are not subject to state laws. ERISA plans are governed by federal law under the jurisdiction of the US Department of Labor (USDOL). The specific benefits or coverage details are found in the Summary Plan Description (SPD). An appeal must go through the insurance company, then to the Employer's Plan Fiduciary. If still required, the Fiduciary's decision can be brought to the USDOL to review for ERISA compliance, and then file a lawsuit in federal court.
The individual insured person's obligations may take several forms:

Premium: The amount the policy-holder or their sponsor (e.g. an employer) pays to the health plan to purchase health coverage.
Deductible: The amount that the insured must pay out-of-pocket before the health insurer pays its share. For example, policy-holders might have to pay a $500 deductible per year, before any of their health care is covered by the health insurer. It may take several doctor's visits or prescription refills before the insured person reaches the deductible and the insurance company starts to pay for care. Furthermore, most policies do not apply co-pays for doctor's visits or prescriptions against your deductible.
Co-payment: The amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 co-payment for a doctor's visit, or to obtain a prescription. A co-payment must be paid each time a particular service is obtained.
Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a co-payment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain.
Exclusions: Not all services are covered. The insured are generally expected to pay the full cost of non-covered services out of their own pockets.
Coverage limits: Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some insurance company schemes have annual or lifetime coverage maxima. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.
Out-of-pocket maxima: Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and health insurance pays all further covered costs. Out-of-pocket maxima can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.
Capitation: An amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer.
In-Network Provider: (U.S. term) A health care provider on a list of providers preselected by the insurer. The insurer will offer discounted coinsurance or co-payments, or additional benefits, to a plan member to see an in-network provider. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the "usual and customary" charges the insurer pays to out-of-network providers.
Prior Authorization: A certification or authorization that an insurer provides prior to medical service occurring. Obtaining an authorization means that the insurer is obligated to pay for the service, assuming it matches what was authorized. Many smaller, routine services do not require authorization.
Explanation of Benefits: A document that may be sent by an insurer to a patient explaining what was covered for a medical service, and how payment amount and patient responsibility amount were determined.
Prescription drug plans are a form of insurance offered through some health insurance plans. In the U.S., the patient usually pays a copayment and the prescription drug insurance part or all of the balance for drugs covered in the formulary of the plan. Such plans are routinely part of national health insurance programs. For example, in the province of Quebec, Canada, prescription drug insurance is universally required as part of the public health insurance plan, but may be purchased and administered either through private or group plans, or through the public plan.

Some, if not most, health care providers in the United States will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay. The insurance company pays out of network providers according to "reasonable and customary" charges, which may be less than the provider's usual fee. The provider may also have a separate contract with the insurer to accept what amounts to a discounted rate or capitation to the provider's standard charges. It generally costs the patient less to use an in-network provider.

Health Insurance

Private healthcare or private medicine is healthcare and medicine provided by entities other than the government. The term is generally used more in Europe and other countries which have publicly funded health care, to differentiate the arrangement from systems where private healthcare is the norm.

Ethical issues relating to private healthcare primarily concerns the argument that the seriously ill be entitled to spend money on saving their lives. On the other hand, private healthcare can sometimes be more efficient than public sector provision. Private operators may be more innovative in areas such as telemedicine. Due to the profit motive, they can be more productive. Public healthcare tends to be limited by the amount of tax that individuals are willing to pay.

Some would argue that private healthcare needs to be more carefully regulated to ensure that it achieves standards set by the state, predominantly regarding safety, value, and efficiency.

Charging patients or private insurers for work

Europeans in all countries are willing to pay a charge for some private healthcare, whether to avoid long queues, to access cosmetic surgery, or to avoid the perceived risk of infection in public-sector hospitals. This is not a small market. In Finland it is estimated that it is worth some €700m a year. In Greece, half the income of private hospitals is from one-off payments from patients. Maternity is a particularly large private market, as it is the demand for fertility both at home and abroad, where more than 18% of medical internet based searches are related to infertility conditions and treatment.[1] Healthcare tourism is also thriving within the EU, in which patients (mainly from the UK) travel to Eastern Europe for low-cost dental work. The particularly wealthy Russians and Saudi Arabians tend to go to private hospitals in Switzerland or Germany.

As most Europeans have access to public sector provision either through their mandatory social insurance fund or through taxes, private healthcare insurance remains a relatively small market, with levels typically in the range of 2%-8% of the population. Many consumers prefer to pay single fees as and when necessary. In addition, any occupational healthcare paid for by employers renders private healthcare insurance unnecessary. Nonetheless, around 10% of Germans have some form of private healthcare insurance which enables them to experience a slightly higher level of comfort during hospital stays. The most notable development in this area has been the Netherlands, which in 2005 moved to a system whereby all citizens are forced to take out private healthcare insurance rather than social insurance. This is being closely monitored by many European countries.

Occupational healthcare

In many European countries with a state-run national health service, employers are obliged to pay for some level of healthcare for their employees. This is the case in Romania, Poland and Finland, for instance, and one can find networks of small clinics in large cities in these countries. In other countries, such as the UK and Sweden, many employers are willing to pay for occupational healthcare for their workforce so that key workers can avoid delays in seeing a doctor when they are unwell. Naturally though, the occupational health department of a publicly funded hospital will provide a similar standard of healthcare to that provided for patients.

Private Health

In the United States, health insurance is any program that helps pay for medical expenses, whether through privately purchased insurance,

social insurance or a social welfare program funded by the government. Synonyms for this usage include "health coverage," "health care

coverage" and "health benefits."

In a more technical sense, the term is used to describe any form of insurance that provides protection against the costs of medical services.

This usage includes private insurance and social insurance programs such as Medicare, which pools resources and spreads the financial

risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs such as

Medicaid and the State Children's Health Insurance Program, which provide assistance to people who cannot afford health coverage.

In addition to medical expense insurance, "health insurance" may also refer to insurance covering disability or long-term nursing or custodial

care needs. Different health insurance provides different levels of financial protection and the scope of coverage can vary widely, with more

than 40 percent of insured individuals reporting that their plans do not adequately meet their needs as of 2007.

The share of Americans with health insurance has been steadily declining since at least 2000. As of 2010 just under 84% of Americans had

some form of health insurance, which meant that more than 49 million people went without coverage for at least part of the year. Declining

rates of coverage and underinsurance are largely attributable to rising insurance costs and high unemployment. As the pool of people with

private health insurance has shrunk, Americans are increasingly reliant on public insurance. Public programs now cover 31% of the population

and are responsible for 44% of health care spending. Public insurance programs tend to cover more vulnerable people with greater health

care needs. Many of the reforms instituted by the Affordable Care Act of 2010 were designed to extend health care coverage to those without it.

Enrollment and the Uninsured

According to the United States Census Bureau, roughly 55% obtain insurance through an employer, while about 10% purchase it directly.

About 31% of Americans were enrolled in a public health insurance program: 14.5% (45 million – although that number has since risen to 48

million) had Medicare, 15.9% (49 million) had Medicaid, and 4.2% (13 million) had military health insurance (there is some overlap, causing

percentages to add up to more than 100%). Employers may also provide reimbursement for health insurance purchased individually by their

employees through a Defined contribution health benefits plan. Employers are allowed to pay employees cash in lieu of health insurance, but

this is uncommon as it is subject to strict IRS regulations.

Trends in private coverage

The percentage of non-elderly workers with employer-sponsored coverage has been falling, from 68% in 2000 to 61% in 2009, the latest year

for which data is available. While the primary cause of falling rates of insurance is the rising cost of health care for employers, the

economic downturn since 2008 has swelled the ranks of the uninsured, in large part because workers who lose their jobs also lose employer-

sponsored insurance. Over 1 million workers lost their health care coverage in January, February and March 2009. Approximately, 268,400

more workers lost health care coverage in March 2009 than in March 2008,[8] so the decline of employer sponsored insurance has likely

accelerated in recent years.

Industry experts expect that in the coming decade there will be a shift to defined contribution health benefits plans, similar to the recent shift in

retirement plans from defined benefit to defined contribution.

Trends in public coverage

As a smaller and smaller share of the public is covered by private insurance, public insurance has grown more essential. In 2000, 10.5% of the

public was covered by Medicaid, while 13.5% had Medicare. By 2010, those figures had risen to 14.5% and 15.9% respectively.

A report published by the Kaiser Family Foundation in April 2008 found that economic downturns dramatically increase the public's reliance on

state Medicaid and SCHIP and can cause significant financial strain for the programs. The authors estimated that a 1% increase in the

unemployment rate would increase Medicaid and SCHIP enrollment by 1 million, and increase the number uninsured by 1.1 million. State

spending on Medicaid and SCHIP would increase by $1.4 billion (total spending on these programs would increase by $3.4 billion). This

increased spending would occur at the same time state government revenues were declining. During the last downturn, the Jobs and Growth

Tax Relief Reconciliation Act of 2003 (JGTRRA) included federal assistance to states, which helped states avoid tightening their Medicaid and

SCHIP eligibility rules. The authors conclude that Congress should consider similar relief for the current economic downturn. Funding for

Medicaid and SCHIP was in fact expanded significantly under the 2010 health reform bill.

Status of the uninsured

Based on self-reported census data, in 2010, more than 49 million people in the US (more than 16% of the population) were without health

insurance as defined in the questions asked. The percentage of the non-elderly population who are uninsured has been generally increasing

since the year 2000. Among the uninsured population, some 40 million were employment-age adults (ages 18 to 64), and more than 28

million worked at least part-time. About 37% of the uninsured live in households with incomes over $50,000.

According to the Census Bureau, more than 40 million of the uninsured are US citizens. Another 9.7 million are non-citizens, but the Census

Bureau does not distinguish in its estimate between documented and undocumented migrants. It has been estimated that nearly one fifth of

the uninsured population is able to afford insurance, almost one quarter is eligible for public coverage, and the remaining 56% need financial

assistance (8.9% of all Americans). An estimated 5 million of those without health insurance are considered "uninsurable" because of pre-

existing conditions.

A 2011 study found that there were 2.1 million hospital stays for uninsured patients, accounting for 4.4 percent ($17.1 billion) of total aggregate

inpatient hospital costs in the United States. The costs of treating the uninsured must often be absorbed by providers as charity care,

passed on to the insured via cost-shifting and higher health insurance premiums, or paid by taxpayers through higher taxes.

Death

Since people who lack health insurance are unable to obtain timely medical care, they have a 40 percent higher risk of death in any given year

than those with health insurance, according to a study published in the American Journal of Public Health. The study estimated that in 2005 in

the United States, there were 45,000 deaths associated with lack of health insurance.

A Johns Hopkins Hospital study found that heart transplant complications occurred most often amongst the uninsured, and that patients who

had private health plans fared better than those covered by Medicaid or Medicare. Gallup issued a report in July 2014 stating that the

uninsured rate for adults 18 and over declined from 18% in 2013 to 13.4% by in 2014, largely due to new coverage options and market reforms

under the Affordable Care Act.[19] Rand Corporation had similar findings

Reform

The Affordable Care Act of 2010 was designed primarily to extend health coverage to those without it by expanding Medicaid, creating financial

incentives for employers to offer coverage, and requiring those without employer or public coverage to purchase insurance in newly created

state-run health insurance exchanges. The CBO has estimated that roughly 33 million who would have otherwise been uninsured will receive

coverage because of the act by 2022.

History

Accident insurance was first offered in the United States by the Franklin Health Assurance Company of Massachusetts. This firm, founded in

1850, offered insurance against injuries arising from railroad and steamboat accidents. Sixty organizations were offering accident insurance in

the US by 1866, but the industry consolidated rapidly soon thereafter. While there were earlier experiments, the origins of sickness coverage in

the US effectively date from 1890. The first employer-sponsored group disability policy was issued in 1911, but this plan's primary purpose was

replacing wages lost due to an inability to work, not medical expenses.

Before the development of medical expense insurance, patients were expected to pay all other health care costs out of their own pockets,

under what is known as the fee-for-service business model. During the middle to late 20th century, traditional disability insurance evolved into

modern health insurance programs. Today, most comprehensive private health insurance programs cover the cost of routine, preventive, and

emergency health care procedures, and also most prescription drugs, but this was not always the case. The rise of private insurance was

accompanied by the gradual expansion of public insurance programs for those who could not acquire coverage through the market.

Hospital and medical expense policies were introduced during the first half of the 20th century. During the 1920s, individual hospitals began

offering services to individuals on a pre-paid basis, eventually leading to the development of Blue Cross organizations in the 1930s. The first

employer-sponsored hospitalization plan was created by teachers in Dallas, Texas in 1929. Because the plan only covered members'

expenses at a single hospital, it is also the forerunner of today's health maintenance organizations (HMOs).

In the 1930s, The Roosevelt Administration explored possibilities for creating a national health insurance program, while it was designing the

Social Security system. But it abandoned the project because the American Medical Association (AMA) fiercely opposed it, along with all forms

of health insurance at that time.

The rise of employer-sponsored coverage

Employer-sponsored health insurance plans dramatically expanded as a direct result of wage controls imposed by the federal government

during World War II. The labor market was tight because of the increased demand for goods and decreased supply of workers during the

war. Federally imposed wage and price controls prohibited manufacturers and other employers from raising wages enough to attract workers.

When the War Labor Board declared that fringe benefits, such as sick leave and health insurance, did not count as wages for the purpose of

wage controls, employers responded with significantly increased offers of fringe benefits, especially health care coverage, to attract workers.

President Harry S. Truman proposed a system of public health insurance in his November 19, 1945, address. He envisioned a national system

that would be open to all Americans, but would remain optional. Participants would pay monthly fees into the plan, which would cover the cost

of any and all medical expenses that arose in a time of need. The government would pay for the cost of services rendered by any doctor who

chose to join the program. In addition, the insurance plan would give a cash balance to the policy holder to replace wages lost due to illness or

injury. The proposal was quite popular with the public, but it was fiercely opposed by the Chamber of Commerce, the American Hospital

Association, and the AMA, which denounced it as "socialism."

Foreseeing a long and costly political battle, many labor unions chose to campaign for employer-sponsored coverage, which they saw as a

less desirable but more achievable goal, and as coverage expanded the national insurance system lost political momentum and ultimately

failed to pass. Using health care and other fringe benefits to attract the best employees, private sector, white-collar employers nationwide

expanded the U.S. health care system. Public sector employers followed suit in an effort to compete. Between 1940 and 1960, the total number

of people enrolled in health insurance plans grew seven-fold, from 20,662,000 to 142,334,000, and by 1958, 75% of Americans had some

form of health coverage.

Medicare and Medicaid

Still, private insurance remained unaffordable or simply unavailable to many, including the poor, the unemployed, and the elderly. Before 1965,

only half of seniors had health care coverage, and they paid three times as much as younger adults, despite having lower incomes.

Consequently, interest persisted in creating public health insurance for those left out of the private marketplace.

The 1960 Kerr-Mills Act provided matching funds to states assisting patients with their medical bills. In the early 1960s, Congress rejected a

plan to subsidize private coverage for people with Social Security as unworkable, and an amendment to the Social Security Act creating a

publicly run alternative was proposed. Finally, President Lyndon B. Johnson signed the Medicare and Medicaid programs into law in 1965,

creating publicly run insurance for the elderly and the poor. Medicare was later expanded to cover people with disabilities, end-stage renal

disease, and ALS.

Towards universal coverage

Persistent lack of insurance among many working Americans continued to create pressure for a comprehensive national health insurance

system. In the early 1970s, there was fierce debate between two alternative models for universal coverage. Senator Ted Kennedy proposed a

universal single-payer system, while President Nixon countered with his own proposal based on mandates and incentives for employers to

provide coverage while expanding publicly run coverage for low-wage workers and the unemployed. Compromise was never reached, and

Nixon's resignation and a series of economic problems later in the decade diverted Congress's attention away from health reform.

Shortly after his inauguration, President Clinton offered a new proposal for a universal health insurance system. Like Nixon's plan, Clinton's

relied on mandates, both for individuals and for insurers, along with subsidies for people who could not afford insurance. The bill would have

also created "health-purchasing alliances" to pool risk among multiple businesses and large groups of individuals. The plan was staunchly

opposed by the insurance industry and employers' groups and received only mild support from liberal groups, particularly unions, which

preferred a single payer system. Ultimately it failed after the Republican takeover of Congress in 1994.

Finally achieving universal health coverage remained a top priority among Democrats, and passing a health reform bill was one of the Obama

Administration's top priorities. The Patient Protection and Affordable Care Act was similar to the Nixon and Clinton plans, mandating coverage,

penalizing employers who failed to provide it, and creating mechanisms for people to pool risk and buy insurance collectively. Earlier

versions of the bill included a publicly run insurer that could compete to cover those without employer sponsored coverage (the so-called

public option), but this was ultimately stripped to secure the support of moderates. The bill passed the Senate in December 2009 with all

Democrats voting in favor and the House in March 2010 with the support of most Democrats. Not a single Republican voted in favor of it either

time.

Public health care coverage

Public programs provide the primary source of coverage for most seniors and also low-income children and families who meet certain

eligibility requirements. The primary public programs are Medicare, a federal social insurance program for seniors (generally persons aged 65

and over) and certain disabled individuals; Medicaid, funded jointly by the federal government and states but administered at the state level,

which covers certain very low income children and their families; and SCHIP, also a federal-state partnership that serves certain children and

families who do not qualify for Medicaid but who cannot afford private coverage. Other public programs include military health benefits

provided through TRICARE and the Veterans Health Administration and benefits provided through the Indian Health Service. Some states have

additional programs for low-income individuals. In 2011, approximately 60 percent of stays were billed to Medicare and Medicaid—up from

52 percent in 1997.

Medicare

In the United States, Medicare is a federal social insurance program that provides health insurance to people over the age of 65, individuals

who become totally and permanently disabled, end stage renal disease (ESRD) patients, and people with ALS. Recent research has found that

the health trends of previously uninsured adults, especially those with chronic health problems, improves once they enter the Medicare

program. Traditional Medicare requires considerable cost-sharing, but ninety percent of Medicare enrollees have some kind of

supplemental insurance - either employer-sponsored or retiree coverage, Medicaid, or a private Medigap plan – that covers some or all of their

cost-sharing. With supplemental insurance, Medicare ensures that its enrollees have predictable, affordable health care costs regardless

of unforeseen illness or injury.

As the population covered by Medicare grows, its costs are projected to rise from slightly over 3 percent of GDP to over 6 percent, contributing

substantially to the federal budget deficit. In 2011, Medicare was the primary payer for an estimated 15.3 million inpatient stays,

representing 47.2 percent ($182.7 billion) of total aggregate inpatient hospital costs in the United States. The Affordable Care Act took

some steps to reduce Medicare spending, and various other proposals are circulating to reduce it further.

Medicare Advantage

Medicare Advantage plans expand the health insurance options for people with Medicare. Medicare Advantage was created under the

Balanced Budget Act of 1997, with the intent to better control the rapid growth in Medicare spending, as well as to provide Medicare

beneficiaries more choices. But on average, Medicare Advantage plans cost 12% more than traditional Medicare. The ACA took steps to

align payments to Medicare Advantage plans with the cost of traditional Medicare.

There is some evidence that Medicare Advantage plans select patients with low risk of incurring major medical expenses to maximize profits

at the expense of traditional Medicare.

Medicaid

Medicaid was instituted for the very poor in 1965. Since enrollees must pass a means test, Medicaid is a social welfare or social protection

program rather than a social insurance program. Despite its establishment, the percentage of US residents who lack any form of health

insurance has increased since 1994. It has been reported that the number of physicians accepting Medicaid has decreased in recent

years due to lower reimbursement rates.

The Affordable Care Act dramatically expanded Medicaid. The program will now cover everyone with incomes under 133% of the federal

poverty level who does not qualify for Medicare, provided this expansion of coverage has been accepted by the state where the person resides.

Meanwhile, Medicaid benefits must be the same as the essential benefit in the newly created state exchanges. The federal government will

fully fund the expansion of Medicaid initially, with some of the financial responsibility gradually devolving back to the states by 2020.

In 2011, there were 7.6 million hospital stays billed to Medicaid, representing 15.6% (approximately $60.2 billion) of total aggregate inpatient

hospital costs in the United States.

State Children's Health Insurance Program (SCHIP)

The State Children's Health Insurance Program (SCHIP) is a joint state/federal program to provide health insurance to children in families who

earn too much money to qualify for Medicaid, yet cannot afford to buy private insurance. The statutory authority for SCHIP is under title XXI of

the Social Security Act. SCHIP programs are run by the individual states according to requirements set by the federal Centers for Medicare and

Medicaid Services, and may be structured as independent programs separate from Medicaid (separate child health programs), as expansions

of their Medicaid programs (SCHIP Medicaid expansion programs), or combine these approaches (SCHIP combination programs). States

receive enhanced federal funds for their SCHIP programs at a rate above the regular Medicaid match.

Military health benefits

Health benefits are provided to active duty service members, retired service members and their dependents by the Department of Defense

Military Health System (MHS). The MHS consists of a direct care network of Military Treatment Facilities and a purchased care network known

as TRICARE. Additionally, veterans may also be eligible for benefits through the Veterans Health Administration.

Pre-existing Condition Insurance Plan

The Pre-existing Condition Insurance Plan, or PCIP, is a transitional program created in the Patient Protection and Affordable Care Act

(PPACA). Those eligible for PCIP are citizens of the United States or those legally residing in the U.S., who have been uninsured for the last 6

months and "have a pre-existing condition or have been denied health coverage because of their health condition." However, if one has health

insurance or is enrolled in a state high risk pool, they are not eligible for PCIP, even if that coverage does not cover their medical condition.

PCIP is run by the individual states or through the U.S. Department of Health and Human Services, which has a contract with the Government

Employees Health Association, or GEHA, to administer benefits. Both will be funded by the federal government and provide three plan options.

These options are the standard, extended, and the Health Savings Account option. PCIP only covers the individual enrollee and does not

include family members or dependents. In 2014, the Affordable Care Act provision banning discrimination based on pre-existing conditions will

be implemented and PCIP enrollees will be transitioned into new state-based health care exchanges.

Private health care coverage

Private health insurance may be purchased on a group basis (e.g., by a firm to cover its employees) or purchased by individual consumers.

Most Americans with private health insurance receive it through an employer-sponsored program. According to the United States Census

Bureau, some 60% of Americans are covered through an employer, while about 9% purchase health insurance directly. Private insurance

was billed for 12.2 million inpatient hospital stays in 2011, incurring approximately 29% ($112.5 billion) of the total aggregate inpatient hospital

costs in the United States.

The US has a joint federal and state system for regulating insurance, with the federal government ceding primary responsibility to the states

under the McCarran-Ferguson Act. States regulate the content of health insurance policies and often require coverage of specific types of

medical services or health care providers. State mandates generally do not apply to the health plans offered by large employers, due to

the preemption clause of the Employee Retirement Income Security Act.

Employer sponsored

Employer-sponsored health insurance is paid for by businesses on behalf of their employees as part of an employee benefit package. Most

private (non-government) health coverage in the US is employment-based. Nearly all large employers in America offer group health insurance

to their employees.[56] The typical large-employer PPO plan is typically more generous than either Medicare or the Federal Employees Health

Benefits Program Standard Option.

The employer typically makes a substantial contribution towards the cost of coverage. Typically, employers pay about 85% of the insurance

premium for their employees, and about 75% of the premium for their employees' dependents. The employee pays the remaining fraction of

the premium, usually with pre-tax/tax-exempt earnings. These percentages have been stable since 1999. Health benefits provided by

employers are also tax-favored: Employee contributions can be made on a pre-tax basis if the employer offers the benefits through a section

125 cafeteria plan.

Although workers are effectively paid less than they would be, because of the cost of insurance premiums to the employer, employer-sponsored

health insurance offers several benefits to workers, including economies of scale, a reduction in adverse selection pressures on the insurance

pool (premiums are lower when all employees participate rather than just the sickest), and reduced income taxes. The disadvantages

include disruptions related to changing jobs, the regressive tax effect (high-income workers benefit far more from the tax exemption for

premiums than low-income workers), and increased spending on healthcare.

Costs for employer-paid health insurance are rising rapidly: since 2001, premiums for family coverage have increased 78%, while wages have

risen 19% and inflation has risen 17%, according to a 2007 study by the Kaiser Family Foundation. Employer costs have risen noticeably

per hour worked, and vary significantly. In particular, average employer costs for health benefits vary by firm size and occupation. The cost per

hour of health benefits is generally higher for workers in higher-wage occupations, but represent a smaller percentage of payroll.[60] The

percentage of total compensation devoted to health benefits has been rising since the 1960s. Average premiums, including both the

employer and employee portions, were $4,704 for single coverage and $12,680 for family coverage in 2008.

However, in a 2007 analysis, the Employee Benefit Research Institute concluded that the availability of employment-based health benefits for

active workers in the US is stable. The "take-up rate," or percentage of eligible workers participating in employer-sponsored plans, has fallen

somewhat, but not sharply. EBRI interviewed employers for the study, and found that others might follow if a major employer discontinued

health benefits. Effective by January 1, 2014, the Patient Protection and Affordable Care Act will impose a $2000 per employee tax penalty on

employers with over 50 employees who do not offer health insurance to their full-time workers. (In 2008, over 95% of employers with at least 50

employees offered health insurance. On the other hand, public policy changes could also result in a reduction in employer support for

employment-based health benefits.

Although much more likely to offer retiree health benefits than small firms, the percentage of large firms offering these benefits fell from 66% in

1988 to 34% in 2002.

Small employer group coverage

According to a 2007 study, about 59% of employers at small firms (3-199 workers) in the US provide employee health insurance. The

percentage of small firms offering coverage has been dropping steadily since 1999. The study notes that cost remains the main reason cited

by small firms who do not offer health benefits.[66] Small firms that are new are less likely to offer coverage than ones that have been in

existence for a number of years. For example, using 2005 data for firms with fewer than 10 employees, 43% of those that had been in existence

at least 20 years offered coverage, but only 24% of those that had been in existence less than 5 years did. The volatility of offer rates from year to

year also appears to be higher for newer small businesses.

The types of coverage available to small employers are similar to those offered by large firms, but small businesses do not have the same

options for financing their benefit plans. In particular, self-funded health care (whereby an employer provides health or disability benefits to

employees with its own funds rather than contracting an insurance company[68]) is not a practical option for most small employers.[69] A

RAND Corporation study published in April 2008 found that the cost of health care coverage places a greater burden on small firms, as a

percentage of payroll, than on larger firms. A study published by the American Enterprise Institute in August 2008 examined the effect of

state benefit mandates on self-employed individuals, and found that "the larger the number of mandates in a state, the lower the probability that

a self-employed person will be a significant employment generator." Beneficiary cost sharing is, on average, higher among small firms than

large firms.

When small group plans are medically underwritten, employees are asked to provide health information about themselves and their covered

family members when they apply for coverage. When determining rates, insurance companies use the medical information on these

applications. Sometimes they will request additional information from an applicant's physician or ask the applicants for clarification.

States regulate small group premium rates, typically by placing limits on the premium variation allowable between groups (rate bands).

Insurers price to recover their costs over their entire book of small group business while abiding by state rating rules. Over time, the effect of

initial underwriting "wears off" as the cost of a group regresses towards the mean. Recent claim experience - whether better or worse than

average - is a strong predictor of future costs in the near term. But the average health status of a particular small employer group tends to

regress over time towards that of an average group. The process used to price small group coverage changes when a state enacts small

group reform laws.

Insurance brokers play a significant role in helping small employers find health insurance, particularly in more competitive markets. Average

small group commissions range from 2 percent to 8 percent of premiums. Brokers provide services beyond insurance sales, such as assisting

with employee enrollment and helping to resolve benefits issues.

College-sponsored health insurance for students

Many colleges, universities, graduate schools, professional schools and trade schools offer a school-sponsored health insurance plan. Many

schools require that you enroll in the school-sponsored plan unless you are able to show that you have comparable coverage from another

source.

Effective group health plan years beginning after September 23, 2010, if an employer-sponsored health plan allows employees' children to

enroll in coverage, then the health plan must allow employees' adult children to enroll as well as long as the adult child is not yet age 26. Some

group health insurance plans may also require that the adult child not be eligible for other group health insurance coverage, but only before

2014.

This extension of coverage will help cover one in three young adults, according to White House documents.

Federal employees health benefit plan (FEHBP)

In addition to such public plans as Medicare and Medicaid, the federal government also sponsors a health benefit plan for federal

employees—the Federal Employees Health Benefits Program (FEHBP). FEHBP provides health benefits to full-time civilian employees.

Active-duty service members, retired service members and their dependents are covered through the Department of Defense Military Health

System (MHS). FEHBP is managed by the federal Office of Personnel Management.

"Portability" of group coverage

Two federal laws address the ability of individuals with employment-based health insurance coverage to maintain coverage.

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) enables certain individuals with employer-sponsored coverage to

extend their coverage if certain "qualifying events" would otherwise cause them to lose it. Employers may require COBRA-qualified individuals

to pay the full cost of coverage, and coverage cannot be extended indefinitely. COBRA only applies to firms with 20 or more employees,

although some states also have "mini-COBRA" laws that apply to small employers.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides for forms of both "group-to-group" and "group-to-individual"

portability. When an individual moves from one employer's benefit plan to another's, the new plan must count coverage under the old plan

against any waiting period for pre-existing conditions, as long as there is not a break in coverage of more than 63 days between the two plans.

When certain qualified individuals lose group coverage altogether, they must be guaranteed access to some form of individual coverage. To

qualify, they must have at least 18 months of prior continuous coverage. The details of access and the price of coverage are determined on a

state-by-state basis.

Association group health insurance

Regular health insurance is sometimes available to members of associations. Associations such as the American Bar Association offer health

insurance to their members,[not in citation given] using an established insurance company to write the policies for a group plan.

Individually purchased

According to the US Census Bureau, about 9% of Americans are covered under health insurance purchased directly. The range of

products available is similar to those provided through employers. However, average out-of-pocket spending is higher in the individual market,

with higher deductibles, co-payments and other cost-sharing provisions. Major medical is the most commonly purchased form of

individual health insurance. Although a major medical health insurance policy is primarily a catastrophic plan, qualified preventive benefits are

still covered at 100% without any waiting period or copay.

In the individual market, the consumer pays the entire premium without benefit of an employer contribution.[80][82] While self-employed

individuals receive a tax deduction for their health insurance and can buy health insurance with additional tax benefits, most consumers in the

individual market do not receive any tax benefit.[83]

Premiums vary significantly by age. In states that allow individual medical plan underwriting, premiums also vary by health status.[80]

However, with the Patient Protection and Affordable Care Act, effective by 2014, all insurers will be fully prohibited from discriminating against or

charging higher rates for any individuals based on pre-existing medical conditions.

In August 2008, the Hartford Courant reported that competition was increasing in the individual health insurance market, with more insurers

entering the market, an increased variety of products, and a broader spread of prices.

Individual health insurance is primarily regulated at the state level, consistent with the McCarran-Ferguson Act. Model acts and regulations

promulgated by the National Association of Insurance Commissioners (NAIC) provide some degree of uniformity state to state. These models

do not have the force of law and have no effect unless they are adopted by a state. They are, however, used as guides by most states, and some

states adopt them with little or no change.

Health

Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific health care goals within a society." According to the World Health Organization, an explicit health policy can achieve several things: it defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people.

There are many categories of health policies, including personal health care policy, pharmaceutical policy, and policies related to public health such as vaccination policy, tobacco control policy or breastfeeding promotion policy. They may cover topics of financing and delivery of health care, access to care, quality of care, and health equity.

Background

Health-related policy and its implementation is complex. Conceptual models can help show the flow from health-related policy development to health-related policy and program implementation and to health systems and health outcomes. Policy should be understood as more than a national law or health policy that supports a program or intervention. Operational policies are the rules, regulations, guidelines, and administrative norms that governments use to translate national laws and policies into programs and services. The policy process encompasses decisions made at a national or decentralized level (including funding decisions) that affect whether and how services are delivered. Thus, attention must be paid to policies at multiple levels of the health system and over time to ensure sustainable scale-up. A supportive policy environment will facilitate the scale-up of health interventions.

There are many topics in the politics and evidence that can influence the decision of a government, private sector business or other group to adopt a specific policy. Evidence-based policy relies on the use of science and rigorous studies such as randomized controlled trials to identify programs and practices capable of improving policy relevant outcomes. Most political debates surround personal health care policies, especially those that seek to reform health care delivery, and can typically be categorized as either philosophical or economic. Philosophical debates center around questions about individual rights, ethics and government authority, while economic topics include how to maximize the efficiency of health care delivery and minimize costs.

The modern concept of health care involves access to medical professionals from various fields as well as medical technology, such as medications and surgical equipment. It also involves access to the latest information and evidence from research, including medical research and health services research.

In many countries it is left to the individual to gain access to health care goods and services by paying for them directly as out-of-pocket expenses, and to private sector players in the medical and pharmaceutical industries to develop research. Planning and production of health human resources is distributed among labour market participants.

Other countries have an explicit policy to ensure and support access for all of its citizens, to fund health research, and to plan for adequate numbers, distribution and quality of health workers to meet health care goals. Many governments around the world have established universal health care, which takes the burden of health care expenses off of private businesses or individuals through pooling of financial risk. There are a variety of arguments for and against universal health care and related health policies. Health care is an important part of health systems and therefore it often accounts for one of the largest areas of spending for both governments and individuals all over the world.

Philosophy: right to health

Many countries and jurisdictions integrate a human rights philosophy in directing their health care policies. The World Health Organization reports that every country in the world is party to at least one human rights treaty that addresses health-related rights, including the right to health as well as other rights that relate to conditions necessary for good health. The United Nations' Universal Declaration of Human Rights (UDHR) asserts that medical care is a right of all people:

UDHR Article 25: "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, illness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."
In some jurisdictions and among different faith-based organizations, health policies are influenced by the perceived obligation shaped by religious beliefs to care for those in less favorable circumstances, including the sick. Other jurisdictions and non-governmental organizations draw on the principles of humanism in defining their health policies, asserting the same perceived obligation and enshrined right to health. In recent years, the worldwide human rights organization Amnesty International has focused on health as a human right, addressing inadequate access to HIV drugs and women's sexual and reproductive rights including wide disparities in maternal mortality within and across countries. Such increasing attention to health as a basic human right has been welcomed by the leading medical journal The Lancet.

There remains considerable controversy regarding policies on who would be paying the costs of medical care for all people and under what circumstances. For example, government spending on health care is sometimes used as a global indicator of a government's commitment to the health of its people. On the other hand, one school of thought emerging from the United States rejects the notion of health care financing through taxpayer funding as incompatible with the (considered no less important) right of the physician's professional judgment, and the related concerns that government involvement in overseeing the health of its citizens could erode the right to privacy between doctors and patients. The argument furthers that universal health insurance denies the right of individual patients to dispose of their own income as per their own will.

Another issue in the rights debate is governments' use of legislation to control competition among private medical insurance providers against national social insurance systems, such as the case in Canada's national health insurance program. Laissez-faire supporters argue that this erodes the cost-effectiveness of the health system, as even those who can afford to pay for private health care services drain resources from the public system. The issue here is whether investor-owned medical insurance companies or health maintenance organizations are in a better position to act in the best interests of their customers compared to government regulation and oversight. Another claim in the United States perceives government over-regulation of the health care and insurance industries as the effective end of charitable home visits from doctors among the poor and elderly.

Economics: health care financing

Many types of health policies exist focusing on the financing of health care services to spread the economic risks of ill health. These include publicly funded health care (through taxation or insurance, also known as single-payer systems), mandatory or voluntary private health insurance, and complete capitalization of personal health care services through private companies, among others. The debate is ongoing on which type of health financing policy results in better or worse quality of health care services provided, and how to ensure allocated funds are used effectively, efficiently and equitably.

There are many arguments on both sides of the issue of public versus private health financing policies:

Claims that publicly funded health care improves the quality and efficiency of personal health care delivery:

Government spending on health is essential for the accessibility and sustainability of health care services and programmes.
For those people who would otherwise go without care due to lack of financial means, any quality care is an improvement.
Since people perceive universal health care as free (if there is no insurance premium or co-payment), they are more likely to seek preventive care which may reduce the disease burden and overall health care costs in the long run.
Single-payer systems reduce wastefulness by removing the middle man, i.e. private insurance companies, thus reducing the amount of bureaucracy. In particular, reducing the amount of paperwork that medical professionals have to deal with for insurance claims processing allows them to concentrate more on treating patients.
Claims that privately funded health care leads to greater quality and efficiencies in personal health care:

Perceptions that publicly funded health care is free can lead to overuse of medical services, and hence raise overall costs compared to private health financing.
Privately funded medicine leads to greater quality and efficiencies through increased access to and reduced waiting times for specialized health care services and technologies.
Limiting the allocation of public funds for personal health care does not curtail the ability of uninsured citizens to pay for their health care as out-of-pocket expenses. Public funds can be better rationalized to provide emergency care services regardless of insured status or ability to pay, such as with the Emergency Medical Treatment and Active Labor Act in the United States.[citation needed]
Privately funded and operated health care reduces the requirement for governments to increase taxes to cover health care costs, which may be compounded by the inefficiencies among government agencies due to their greater bureaucracy.

Medical research policy

Medical research can be both the basis for defining evidence-based health policy, and the subject of health policy itself, particularly in terms of its sources of funding. Those in favor of government policies for publicly funded medical research posit that removing profit as a motive will increase the rate of medical innovation. Those opposed argue that it will do the opposite, because removing the incentive of profit removes incentives to innovate and inhibits new technologies from being developed and utilized.

The existence of sound medical research does not necessarily lead to evidence-based policymaking. For example, in South Africa, whose population sets the record for HIV infections, previous government policy limiting funding and access for AIDS treatments met with strong controversy given its basis on a refusal to accept scientific evidence on the means of transmission. A change of government eventually led to a change in policy, with new policies implemented for widespread access to HIV services. Another issue relates to intellectual property, as illustrated by the case of Brazil, where debates have arisen over government policy authorizing the domestic manufacture of antiretroviral drugs used in the treatment of HIV/AIDS in violation of drug patents.

Health workforce policy

Some countries and jurisdictions have an explicit policy or strategy to plan for adequate numbers, distribution and quality of health workers to meet health care goals, such as to address physician and nursing shortages. Elsewhere, health workforce planning is distributed among labour market participants as a laissez-faire approach to health policy. Evidence-based policies for health workforce development are typically based on findings from health services research.

Health in foreign policy

Many governments and agencies include a health dimension in their foreign policy in order to achieve global health goals. Promoting health in lower income countries has been seen as instrumental to achieve other goals on the global agenda, including:

Promoting global security – linked to fears of global pandemics, the intentional spread of pathogens, and a potential increase in humanitarian conflicts, natural disasters, and emergencies;
Promoting economic development – including addressing the economic effect of poor health on development, of pandemic outbreaks on the global market place, and also the gain from the growing global market in health goods and services;
Promoting social justice – reinforcing health as a social value and human right, including supporting the United Nations' Millennium Development Goals.

Global health policy

Global health policy encompasses the global governance structures that create the policies underlying public health throughout the world. In addressing global health, global health policy "implies consideration of the health needs of the people of the whole planet above the concerns of particular nations." Distinguished from both international health policy (agreements among sovereign states) and comparative health policy (analysis of health policy across states), global health policy institutions consist of the actors and norms that frame the global health response.

Health Plan

Women's health refers to a state of complete physical, mental, and social well-being, as experienced by women, and not merely the absence of disease or infirmity. Some of these relate to structures such as female genitalia and breasts or to conditions caused by hormones specific to, or most notable in, females (e.g. menstruation, birth control, maternal health, child birth, menopause and breast cancer). Some conditions that affect both men and women, such as cardiovascular disease, osteoporosis, also manifest differently in women. Women's health issues also include medical situations in which women face problems not directly related to their biology, such as gender-differentiated access to medical treatment and other socioeconomic factors. Worldwide, women and girls are at greater risk of HIV/AIDS – a phenomenon associated with unsafe sexual activity that is often unconsensual.

Women's health is an issue which has been taken up by many feminists, especially where reproductive health is concerned. Women's health is positioned within a wider body of knowledge cited by, amongst others, the World Health Organisation, which places importance on gender as a social determinant of health.

Some health and medical research advocates, particularly the Society for Women's Health Research in the United States, define women's health more broadly than issues specific to human female anatomy to include areas where biological sex differences between women and men exist. Traditionally, women have been underrepresented in clinical trials. However, research has demonstrated significant biological differences between the sexes in rates of susceptibility, symptoms and response to treatment in many major areas of health, including heart disease and some cancers.

The social view of health combined with the acknowledgement that gender is a social determinant of health inform women's health service delivery in countries around the world. Women's health is affected not just by their biology, but also by their social conditions, such as poverty, employment, and family responsibilities. Women's health services such as Leichhardt Women's Community Health Centre which was established in 1974 and was the first women's health centre established in Australia is an example of women's health approach to service delivery.

Issues in reproductive health

One example of this is the Cartwright Inquiry in New Zealand, in which research by two feminist journalists revealed that women with cervical abnormalities were not receiving treatment, as part of an experiment. The women were not told of the abnormalities and several later died. In many countries feminists have campaigned for the right to legal and safe abortion, arguing that it is a health rather than a moral issue. In countries where contraception is difficult to access, campaigns for readily available contraception are conducted on the same lines. Conversely, there have also been campaigns against potentially dangerous forms of contraception such as defective IUDs.

Women's Health Issues

Women's Health Issues is a bimonthly peer-reviewed medical journal covering women's health care and policy. It is the official journal of the Jacobs Institute of Women's Health and published on their behalf by Elsevier. The editor-in-chief is Chloe E. Bird (RAND Corporation).

Health womens

Monday, October 5, 2015

Health care or healthcare is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in human beings. Health care is delivered by practitioners in allied health, dentistry, midwifery (obstetrics), medicine, nursing, optometry, pharmacy, psychology and other health professions. It refers to the work done in providing primary care, secondary care, and tertiary care, as well as in public health.
Access to health care varies across countries, groups, and individuals, largely influenced by social and economic conditions as well as the health policies in place. Countries and jurisdictions have different policies and plans in relation to the personal and population-based health care goals within their societies. Health care systems are organizations established to meet the health needs of target populations. Their exact configuration varies between national and subnational entities. In some countries and jurisdictions, health care planning is distributed among market participants, whereas in others, planning occurs more centrally among governments or other coordinating bodies. In all cases, according to the World Health Organization (WHO), a well-functioning health care system requires a robust financing mechanism; a well-trained and adequately-paid workforce; reliable information on which to base decisions and policies; and well maintained health facilities and logistics to deliver quality medicines and technologies.
Health care can contribute to a significant part of a country's economy. 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 USA (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 USA (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 Mexico and the USA. (see also international comparisons.)
Health care is conventionally regarded as an important determinant in promoting the general physical and mental health and well-being of people around the world. An example of this was the worldwide eradication of smallpox in 1980, declared by the WHO as the first disease in human history to be completely eliminated by deliberate health care interventions.

Health care delivery

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

Primary care

Primary care refers to the work of health professionals who act as a first point of consultation for all patients within the health care system. Such a professional would usually be a primary care physician, such as a general practitioner or family physician, a licensed independent practitioner such as a physiotherapist, or a non-physician primary care provider (mid-level provider) such as a physician assistant or nurse practitioner. Depending on the locality, health system organization, and sometimes at the patient's discretion, they may see another health care professional first, such as a pharmacist, a nurse (such as in the United Kingdom), a clinical officer (such as in parts of Africa), or an Ayurvedic or other traditional medicine professional (such as in parts of Asia). Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.
Primary care is often used as the term for the health care services which play a role in the local community. It can be provided in different settings, such as Urgent care centres which provide services to patients same day with appointment or walk-in bases.
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 manner 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 by the reason for the patient visit.
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.
In the United States, primary care physicians have begun to deliver primary care outside of the managed care (insurance-billing) system through direct primary care which is a subset of the more familiar concierge medicine. Physicians in this model bill patients directly for services, either on a pre-paid monthly, quarterly, or annual basis, or bill for each service in the office. Examples of direct primary care practices include Foundation Health in Colorado and Qliance in Washington.
In 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. The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary health care strategy.

Secondary care

Secondary care is the health care services provided by medical specialists and other health professionals who generally do not have first contact with patients, for example, cardiologists, urologists and dermatologists.
It includes acute care: necessary treatment for a short period of time for a brief but serious illness, injury or other health condition, such as in a hospital emergency department. It also includes skilled attendance during childbirth, intensive care, and medical imaging services.
The "secondary care" is sometimes used synonymously with "hospital care". However many secondary care providers do not necessarily work in hospitals, such as psychiatrists, clinical psychologists, occupational therapists or physiotherapists (physiotherapists are also primary care providers and a referral is not required to see a physiotherapist), and 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.
For example, in the United States, which operates under a mixed market health care system, some physicians might voluntarily limit their practice to secondary care by requiring patients to see a primary care provider first, or this restriction may be imposed under the terms of the payment agreements in private or group health insurance plans. In other cases medical specialists may see patients without a referral, and patients may decide whether self-referral is preferred.
In the United Kingdom and Canada, patient self-referral to a medical specialist for secondary care is rare as prior referral from another physician (either a primary care physician or another specialist) is considered necessary, regardless of whether the funding is from private insurance schemes or national health insurance.
Allied health professionals, such as physical therapists, respiratory therapists, occupational therapists, speech therapists, and dietitians, also generally work in secondary care, accessed through either patient self-referral or through physician referral.

Tertiary care

Tertiary care is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.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.

Quaternary care

The term quaternary care is sometimes used as an extension of tertiary care in reference to advanced levels of medicine which are highly specialized and not widely accessed. Experimental medicine and some types of uncommon diagnostic or surgical procedures are considered quaternary care. These services are usually only offered in a limited number of regional or national health care centres. This term is more prevalent in the United Kingdom, but just as applicable in the United States. A quaternary care hospital may have virtually any procedure available, whereas a tertiary care facility may not offer a sub-specialist with that training.

Home and community care

Many types of health care interventions are delivered outside of health facilities. They include many interventions of public health interest, such as food safety surveillance, distribution of condoms and needle-exchange programmes for the prevention of transmissible diseases.
They also include the services of professionals in residential and community settings in support of self care, home care, long-term care, assisted living, treatment for substance use disorders and other types of health and social care services.
Community rehabilitation services can assist with mobility and independence after loss of limbs or loss of function. This can include prosthesis, orthotics or wheelchairs.
Many countries, especially in the west are dealing with aging populations, and 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, transporting them to doctor's appointments, and many other activities that are so 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 for home care.
With obesity in children rapidly becoming a major concern, health services often set up programs in schools aimed at educating children in good eating habits; making physical education compulsory in school; and teaching young adolescents to have positive self-image.