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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Sir Eldryd Hugh Owen Parry, KCMG, OBE is a Welsh academic, currently professor at Emmanuel College, Cambridge.^[1] Parry is a physician and founder of the Tropical Health and Education Trust,^[2] which helps African medical schools and hospitals to improve staff skill levels.

Parry has an honorary DSc (Kumasi) and a number of honorary Fellowships, and is a founding member of the Faculty of Medicine and Surgery, Amoud University, Somaliland. He is the founder of the Tropical Health and Education Trust (THET) (www.thet.org) and senior editor of Principles of Medicine in Africa (revised edition, 2004).

He studied medicine at Emmanuel College, Cambridge , and at Cardiff University, before moving to University College Hospital, Ibadan, Nigeria, in 1960. After three years at Haile Selassie University, Addis Ababa, Ethiopia, he returned to Nigeria in 1969 as the Chair of Medicine at Ahmadu Bello University, Zaria, Nigeria. in 1977 he took the post of Foundation Dean of Medicine, at the University of Ilorin, Nigeria. It was in Ilorin that he introduced a radical community based programme, COBES with Professor Ladipo Akinkugbe. He was Dean and Professor of Medicine at the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, from 1980-1985.

He is an Honorary Fellow of the University of Cardiff and of the London School of Hygiene and Tropical Medicine, where he is also an Honorary Professor; an honorary Foundation Fellow at the College of Physicians and Surgeons of Ghana, and a Foundation Member of the Faculty of Medicine and Surgery of Amoud University, Somaliland.

He founded the Tropical Health and Education Trust in London, in 1988.

In 2007, Parry received a lifetime achievement award from the Royal Society of Medicine for achievement in tropical medicine, and was made an Honorary Fellow of Emmanuel College, Cambridge. He is also an Honorary Fellow of the Royal College of Surgeons of England. He was appointed Officer of the Order of the British Empire (OBE) in 1982 and Knight Commander of the Order of St Michael and St George (KCMG) in the 2011 New Year Honours for services to healthcare development in Africa.^[3]

The third edition of Principles of Medicine in Africa won: Society of Authors and Royal Society of Medicine Book Awards Winner 2005 - Winner 2005 British Medical Association First Prize in its category 2005 - Winner

He is married to the academic Helen Parry; they have four children and four grandchildren^[4]

Footnotes[link]

References[link]

• http://news.bbc.co.uk/2/hi/uk_news/wales/7475796.stm
• http://www.wales.nhs.uk/sites3/Documents/444/Eldryd%20Parry.pdf
• J R Soc Med. 2004 September; 97(9): 451–452.
• The Anglo-Ethiopian Society http://www.anglo-ethiopian.org/publications
• Trop Doct 2008;38:69 Royal Society of Medicine Press Medical Education Volume 32, Issue 6, pages 630–635, November 1998
• www.thelancet.com/journals/lancet/
• http://www.nigeriansinamerica.com/articles/3053/1/Restoring-Health-To-The-Agenda-In-Nigeria---Report-From-A-Conference/Page1.html

This biographical article needs additional citations for verification. Please help by adding reliable sources. Contentious material about living persons that is unsourced or poorly sourced must be removed immediately, especially if potentially libelous or harmful. (September 2007)

Jeffrey Carl Simpson, OC (born 17 Feb 1949 in New York City, New York), is a Canadian journalist. He has been The Globe and Mail's national affairs columnist for almost three decades. He has won all three of Canada's leading literary prizes — the Governor General's Award for non-fiction book writing, the National Magazine Award for political writing, and the National Newspaper Award [1] for column writing. He has also won the Hyman Solomon Award [2] for excellence in public policy journalism. In January, 2000, he became an Officer of the Order of Canada.

Biography[link]

Simpson was born in New York and moved to Canada when he was 10 years old. He was educated at the University of Toronto Schools. He graduated from Queen's University in 1971 in History and Political Science. While at Queen's he worked for the campus radio station CFRC. He won the University's Tricolour Award in his graduating year. He then went on to the London School of Economics. In 1972–1973, he worked as a Parliamentary Intern in Ottawa where he worked for Ed Broadbent. A year later, he joined The Globe and Mail newspaper.

Career[link]

His ongoing career with the Globe began at City Hall in Toronto and with coverage of Quebec politics. In 1977, he became a member of the paper's Ottawa bureau, and eighteen months later he was named The Globe and Mail's Ottawa bureau chief. From 1981–1983, Simpson served as The Globe and Mail's European correspondent based in London. Since January, 1984 he has written a critically acclaimed daily column on national affairs.

He has written numerous magazine articles for such publications as Saturday Night, Report on Business Magazine, the Journal of Canadian Studies and Queen's Quarterly. He has spoken at dozens of major conferences in Canada and internationally on a variety of domestic and international issues.

Mr. Simpson is a frequent and enthusiastic participant in regular political debate on radio or television, in French and in English. He has been a guest lecturer at such universities as Oxford, Edinburgh, Harvard, Princeton, Brigham Young, Johns Hopkins, Maine, California plus more than a dozen universities in Canada.

In 1993–1994, Simpson was on leave from his column as a John S. Knight fellow at Stanford University in Palo Alto, California. He has been a Skelton-Clark fellow and Brockington Visitor at Queen's University. He has also been a John V. Clyne fellow at the University of British Columbia, a distinguished visitor at the University of Alberta and a member of the Georgetown University Leadership Seminar. He has been awarded honorary doctorates of laws from the University of British Columbia and the University of Western Ontario.

Simpson has been a member of the board of trustees at Queen's University; the board of overseers at Green College, University of British Columbia; the advisory board of the Review of Constitutional Studies at the University of Alberta; the editorial board of The Queen's Quarterly, and the Canadian Consortium for Asia-Pacific Security at York University and the University of Toronto. He has been vice-chairman of the City of Ottawa Library Board.

Simpson is a Senior Fellow at the University of Ottawa’s Graduate School of Public and International Affairs.[3]

In 2006, Simpson was awarded the Charles Lynch Award in recognition of his outstanding coverage of national issues.

Simpson is also an outspoken critic of the monarchy of Canada and has written in favour of republicanism in his column.^[1]

Mr. Simpson is an avid Ottawa Senators fan and in 2011 attempted to convince the team to replace its general manager, referencing his position as the Globe's national affairs columnist on the newspaper's letterhead to demand the change.^[2] He threatened to not renew his season tickets, if the team did not fire the GM.

He is also a member of the Trilateral Commission^[3]

Books authored[link]

Simpson has authored seven books:

• 1980 - Discipline of Power, winner of the 1980 Governor General's Award for Non-Fiction.
• 1988 - Spoils of Power
• 1993 - Faultines, Struggling for a Canadian Vision
• 1996 - The Anxious Years
• 2000 - Star-Spangled Canadians
• 2001 - The Friendly Dictatorship
• 2007 - Hot Air: Meeting Canada's Climate Change Challenge (co-authored with Mark Jaccard and Nic Rivers)

See also[link]

• List of newspaper columnists

References[link]

1. ^ "When is Canada going to grow up?"
2. ^ http://www.the6thsens.com/2011-articles/january/reactions858589.html
3. ^ http://www.trilateral.org/download/file/TC_%20list_5-12%20(2).pdf

• Information provided by The Globe and Mail, Toronto, Ontario.