Health care (or healthcare) is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers. 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 from country to country. In some countries and jurisdictions, health care planning is distributed among market participants, whereas in others planning is made 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 facilities and logistics to deliver quality medicines and technologies.^[1]

Health care can form a significant part of a country's economy. In 2008, the health care industry consumed an average of 9.0 percent of the gross domestic product (GDP) across the most developed OECD countries.^[2] The United States (16.0%), France (11.2%), and Switzerland (10.7%) were the top three spenders.

Health care is conventionally regarded as an important determinant in promoting the general health and well-being of people around the world. An example of this is 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.^[3]

Health care delivery[link]

Primary care may be provided in community health centres.

The delivery of modern health care depends on groups of trained professionals and paraprofessionals coming together as interdisciplinary teams.^[4][5] This includes professionals in medicine, nursing, dentistry 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.^[6]

Primary care[link]

Medical train "Therapist Matvei Mudrov" in Khabarovsk, Russia

Primary care is the term for the health care services which play a role in the local community. It refers to the work of health care professionals who act as a first point of consultation for all patients within the health care system.^[6][7] Such a professional would usually be a primary care physician, such as a general practitioner or family physician, or a non-physician primary care 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 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.^[8]

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 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 around the world, in both developed and developing countries.^[9][10] The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary health care strategy.^[6]

Secondary care[link]

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 or physiotherapists, 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/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[link]

The National Hospital for Neurology and Neurosurgery in London, United Kingdom is a specialist neurological hospital.

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.^[11]

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.^[12]

Quaternary care[link]

The term quaternary care is also used sometimes as an extension of tertiary care in reference to medicine of advanced levels 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.^[12][13]

Home and community care[link]

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.

Related sectors[link]

Health care extends beyond the delivery of services to patients, encompassing many related sectors, and set within a bigger picture of financing and governance structures.

Health system[link]

A health system, also sometimes referred to as health care system or healthcare system is the organization of people, institutions, and resources to deliver health care services to meet the health needs of target populations.

Health care industry[link]

A group of Chilean 'Damas de Rojo' volunteering at their local hospital.

The health care industry incorporates several sectors that are dedicated to providing health care services and products. As a basic framework for defining the sector, the United Nations' International Standard Industrial Classification categorizes health care as generally consisting of hospital activities, medical and dental practice activities, and "other human health activities". The last class involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics, residential health facilities, or other allied health professions, e.g. in the field of optometry, hydrotherapy, medical massage, yoga therapy, music therapy, occupational therapy, speech therapy, chiropody, homeopathy, chiropractics, acupuncture, etc.^[14]

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 as well as biotechnology, diagnostic laboratories and substances, and drug manufacturing and delivery.

For example, pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States.^[15][16] The United States dominates the biopharmaceutical field, accounting for three-quarters of the world’s biotechnology revenues.^[17][15]

Health care research[link]

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, including biomedical research and pharmaceutical research. They form the basis of evidence-based medicine and evidence-based practice in health care delivery.

For example, in terms of pharmaceutical research and development spending, Europe spends a little less than the United States (€22.50bn compared to €27.05bn in 2006). The United States accounts for 80% of the world's research and development spending in biotechnology.^[15][17]

In addition, the results of 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 population healthier.^[18] 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 AI for the development of systems of health assessment that are clinically useful, timely, sensitive to change, culturally sensitive, low burden, low cost, involving for the patient and built into standard procedures.^[19]

Health care financing[link]

There are generally five primary methods of funding health care systems:^[20]

1. general taxation to the state, county or municipality
2. social health insurance
3. voluntary or private health insurance
4. out-of-pocket payments
5. donations to health charities

In most countries, the financing of health care services features a mix of all five models, but the exact distribution varies across countries and over time within countries. In all countries and jurisdictions, 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 health policy regarding the financing structure.

For example, social health insurance is where a nation's entire population is eligible for health care coverage, and this coverage and the services provided are regulated. In almost every jurisdiction with a government-funded health care system, a parallel private, and usually for-profit, system is allowed to operate. This is sometimes referred to as two-tier health care or universal health care.

Health care administration and regulation[link]

The management and administration of health care is another sector vital to the delivery of health care services. In particular, the practice of health professionals and operation of health care institutions is typically regulated by national or state/provincial authorities through appropriate regulatory bodies for purposes of quality assurance.^[21] Most countries have credentialing staff in regulatory boards or health departments who document the certification or licensing of health workers and their work history.^[22]

Health information technology[link]

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” (Brailer, & Thompson, 2004). Technology is a broad concept that deals with a species' usage and knowledge of tools and crafts, and how it affects a species' ability to control and adapt to its environment. However, a strict definition is elusive; "technology" can refer to material objects of use to humanity, such as machines, hardware or utensils, but can also encompass broader themes, including systems, methods of organization, and techniques. For HIT, technology represents computers and communications attributes that can be networked to build systems for moving health information. Informatics is yet another integral aspect of HIT.

See also[link]

	Medicine portal
	Health and fitness portal
	Society portal

• Acronyms in healthcare
• Healthcare system / Health care provider
• Health center / Clinic / Hospital / Nursing Home
• Medicine / Doctor's visit / Nursing
• Philosophy of healthcare
  • Social service / Social determinants of health
  • Family medicine / Preventive medicine / Social medicine
  • Community health service / Community health centers in the United States
  • Direct primary care (United States)
• Health policy
  • Health insurance / Insurance /Social health insurance / Subsidies
  • Health care reform / Health care reform in the United States
  • Healthy city / Alliance for Healthy Cities
• Universal health care
  • Health care in the United States as a private system
  • Healthcare in the United Kingdom
  • Healthcare in Cuba as a state owned system
  • Health in Germany as a private system under state controlled insurance
  • Primary Health Organisation (New Zealand)
• Medical classification
  • ATC codes (Anatomical Therapeutic Chemical classification system)
  • Classification of Pharmaco-Therapeutic Referrals (CPR)
  • ICD-10 (International Classification of Diseases)
  • International Classification of Primary Care (ICPC-2) / ICPC-2 PLUS

Notes[link]

External links[link]

Wikimedia Commons has media related to: Health care

• HR3200: America's Affordable Health Choices Act of 2009
• Health Care Policymakers at WhoRunsGov at The Washington Post
• Defining Primary Care from Institute of Medicine IOM—Primary Care: America's Health in a New Era (1996)
• Primary Care Definitions from American Academy of Family Physicians AAFP
• Definition of Primary Care from American Medical Association AMA
• Defining primary health care Department of Health United Kingdom UK
• What is primary health care? Aboriginal Medical Services Alliance Northern Territory (AMSANT) Australia
• Primary Care Diabetes Journal

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Rebecca Onie (born 1977) is co-founder and Chief Executive Officer of Health Leads.^[1]

In 1996, during her sophomore year at Harvard College, Rebecca Onie founded Health Leads (formerly Project HEALTH) with Dr. Barry Zuckerman, Chair of Pediatrics at Boston Medical Center. As Executive Director of Health Leads, Rebecca oversaw the organization's growth to Providence and New York City.

After attending Harvard Law School, where she served as an editor of the Harvard Law Review and research assistant for Professors Laurence Tribe and Lani Guinier, Rebecca clerked for the Honorable Diane P. Wood of the U.S. Court of Appeals for the Seventh Circuit. She was also an associate at Miner, Barnhill & Galland P.C., a boutique law firm in Chicago, where she represented civil rights plaintiffs, health centers, affordable housing developers, and nonprofits.

During this time, Rebecca served as founding Co-Chair of Health Leads' Board of Directors. She returned to Health Leads as CEO in February 2006.

In 2009, she was honored to receive a MacArthur Fellowship, for “individuals who have shown extraordinary originality and dedication in their creative pursuits and a marked capacity for self-direction.” Most recently, O! Magazine named her to its 2010 Power List of twenty women who are “changing the world for the better.”

In 2012, Rebecca spoke at TEDMED on the devastating impact of poverty on health. Entitled, "Can We Rewrite the DNA of the Healthcare System," her talk focused on Health Leads' role in helping doctors connect their low-income patients with better access to health services, interventions, food and transportation.^[2]

Rebecca is a World Economic Forum Young Global Leader and a U.S. Ashoka Fellow. She received the John F. Kennedy New Frontier Award in 2009, honoring Americans under the age of 40 whose commitment to service is changing their communities and the country; the Jane Rainie Opel ’50 Young Alumna Award in 2008, for outstanding contributions to the advancement of women; and the Do Something Brick Award for Community Leadership in 1999, for dynamic young people under the age of thirty with the passion and drive to improve their communities.^[3][4]

Awards[link]

• 2011 Forbes Magazine's list of top social entrepreneurs in the world.^[5]
• 2011 Skoll Award for Social Entrepreneurship^[6]
• 2010 Elfenworks "In Harmony with Hope" Award^[7]
• 2010 "25 Visionaries Who Are Changing Your World", Utne Reader^[8]
• 2009 MacArthur Fellows Program
• John F. Kennedy New Frontier Award^[9][10]
• 2008 U.S. Ashoka Fellow^[11]
• 1999 Do Something Brick Award for Community Leadership

References[link]

External links[link]

• "Rebecca Onie: Doing Something about the Situation of Medical Care", The Situationist, Jon Hanson, October 7, 2009
• "Social Enterprise + Preventative Healthcare + Service = Project HEALTH", Fast Company, Alice Korngold, Aug 21, 2009
• "Health Leads' Wikipedia page"