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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Ben Carson
Carson being announced as a recipient of the Presidential Medal of Freedom at the White House on June 20, 2008.
Born	Benjamin Solomon Carson (1951-09-18) September 18, 1951 (age 60) Detroit, Michigan, United States
Nationality	American
Fields	Neurosurgery, psychiatry
Institutions	Johns Hopkins Hospital
Alma mater	Yale University University of Michigan Medical School
Known for	Pediatric neurosurgery
Notable awards	Presidential Medal of Freedom (2008)

Benjamin Solomon "Ben" Carson, Sr., (born September 18, 1951) is an American neurosurgeon and the Director of Pediatric Neurosurgery at Johns Hopkins Hospital. He was awarded the Presidential Medal of Freedom, the highest civilian award in the United States, by President George W. Bush in 2008.

Early life[link]

Carson was born in Detroit, Michigan and was raised by his single mother, Sonya Carson. He struggled academically throughout elementary school, but started to excel in middle school and throughout high school. After graduating with honors from his high school, he attended Yale University, where he earned a degree in Psychology. He chose to go to Yale because in College Bowl, an old TV program, he saw Yale compete against and defeat many other colleges in knowledge, including Harvard. Carson wanted to participate in College Bowl, but the program was discontinued. From Yale, he attended University of Michigan Medical School.

Career[link]

Carson's eye-hand coordination and three-dimensional reasoning skills made him a gifted surgeon.^[1] After medical school he became a neurosurgery resident at Johns Hopkins Hospital in Baltimore. Starting off as an adult neurosurgeon Carson became more interested in pediatrics. With children he believed that "what you see is what you get,^[2] ... when they’re in pain they clearly show it with a frown on their face or when they are happy they show it by smiling brightly." Since then he has been the head of the pediatric neurosurgeon department.^[3]

At age 33, he became the hospital's youngest major division director, as Director of Pediatric Neurosurgery. Carson's other surgical innovations have included the first intrauterine procedure to relieve pressure on the brain of a hydrocephalic fetal twin, and a hemispherectomy, in which a young girl suffering from uncontrollable seizures had one half of her brain removed.

In 1987, Carson made medical history by being the first surgeon to successfully separate siamese twins (the Binder twins) conjoined at the back of the head (craniopagus twins). The 70-member surgical team, led by Carson, worked for 22 hours. At the end, the twins were successfully separated and can now survive independently. Carson recalls:

I looked at that situation. I said, ‘Why is it that this is such a disaster?’ and it was because they would always exsanguinate. They would bleed to death, and I said, ‘There's got to be a way around that. These are modern times.’ This was back in 1987. I was talking to a friend of mine, who was a cardiothoracic surgeon, who was the chief of the division, and I said, ‘You guys operate on the heart in babies, how do you keep them from exsanguinating’ and he says, ‘Well, we put them in hypothermic arrest.’ I said, ‘Is there any reason that -- if we were doing a set of Siamese twins that were joined at the head -- that we couldn't put them into hypothermic arrest, at the appropriate time, when we're likely to lose a lot of blood?’ and he said, ‘No way .’ I said, ‘Wow, this is great.’ Then I said, ‘Why am I putting my time into this? I'm not going to see any Siamese twins.’ So I kind of forgot about it, and lo and behold, two months later, along came these doctors from Germany, presenting this case of Siamese twins. And, I was asked for my opinion, and I then began to explain the techniques that should be used, and how we would incorporate hypothermic arrest, and everybody said ‘Wow! That sounds like it might work.’ And, my colleagues and I, a few of us went over to Germany. We looked at the twins. We actually put in scalp expanders, and five months later we brought them over and did the operation, and lo and behold, it worked.^[4]

Awards and honors[link]

Carson has received numerous honors and many awards over the years, including over 61 honorary doctorate degrees. He was also a member of the American Academy of Achievement, the Horatio Alger Association of Distinguished Americans, the Alpha Omega Alpha Honor Medical Society, the Yale Corporation (the governing body of Yale University), and other prestigious organizations. He sits on many boards including the Board of Directors of Kellogg Company, Costco Wholesale Corporation, and America's Promise. He was also the president and co-founder of the Carson Scholars Fund, which recognizes young people of all backgrounds for exceptional academic and humanitarian accomplishments. In 2007, Carson was inducted into the Indiana Wesleyan University Society of World Changers and received an honorary doctorate while speaking at the university. He returned to IWU the following year when his friend, Tony Dungy, was also inducted into the society.^[5] On June 19, 2008, Carson received the Presidential Medal of Freedom from President George W. Bush. He is a recipient of the Ford's Theatre Lincoln Medal and the William E. Simon Prize for Philanthropic Leadership, and was elected to the Institute of Medicine (IOM) of the United States National Academy of Sciences.

Publications and appearances[link]

Carson has written four bestselling books published by Zondervan, an international Christian media and publishing company: Gifted Hands, The Big Picture, Take the Risk, and Think Big. The first book is an autobiography and two are about his personal philosophies of success that incorporate hard work and a faith in God; Carson is a Seventh-day Adventist. In a debate with Richard Dawkins, Francis Collins, and Daniel Dennett, Carson stated he doesn't believe in evolution: "I don't believe in evolution...evolution says that because there are these similarities, even though we can't specifically connect them, it proves that this is what happened."^[6]

A video documentary about Carson's life titled Gifted Hands: The Ben Carson Story was released by Zondervan in 1992. Subsequently in 2009, a separate television movie with the same title premiered on TNT on February 7, 2009, with Academy Award winner Cuba Gooding Jr. in the lead role and Kimberly Elise portraying his mother.^[7]

Personal life[link]

In June 2002 Carson was forced to cut back on his public appearances when he was diagnosed with prostate cancer, but the cancer was caught in time. He still operates on more than 300 children a year, but has been trying to shorten his days: prior to his cancer he used to work from 7:00 in the morning until 8:00 at night.^[8]

Carson married Candy Rustin, whom he met at Yale in 1975; she holds a M.B.A. degree and is an accomplished musician, and both are members of the Seventh-day Adventist Church.

Appearance in Popular Culture[link]

In The Wire season 4 episode Corner Boys, upon being asked where he sees himself in ten years, Calvin responds that he "want[s] to be a pediatric neurosurgeon like that one nigga," referring to Carson, who had been prominent in local and national news in the period during which the episode was written.

Publications[link]

Wikiquote has a collection of quotations related to: Ben Carson

• (2009) Gifted Hands: The Ben Carson Story, Zondervan Publishing. ISBN 0-310-21469-6
• (2008) Take The Risk, Zondervan Publishing. ISBN 0-310-25973-8
• (2000) The Big Picture, Zondervan Publishing. ISBN 0-310-23834-X
• (1996) Think Big, Zondervan Publishing. ISBN 0-310-21459-9
• (1990) Gifted Hands: The Ben Carson Story, Review & Herald Pub., ISBN 0-8280-0669-5

References[link]

External links[link]

• Ben Carson interviewed on Conversations from Penn State
• Everyday Matters Magazine Interview with Dr. Ben Carson
• Home Page of the Carson Scholars Fund
• Dr. Ben Carson M.D.
• Benjamin Carson receives a Presidential Medal
• Dr. Benjamin Carson - Pediatric Neurosurgery
• There Is No Job More Important Than Parenting: NPR Interview With Dr. Benjamin Carson
• Dr. Ben Carson: The Gifted Hands Interview with Kam Williams