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THIS IS HEALTH FOR
ALL KENEZIANS; all you need to know ABOUT HEALTH CARE SYSTEMS WORLDWIDE
The Theory & Practice of Interdisciplinary
Therapeutic Organisation
founded by Hafani Research Consortium
Compiled by the ANIMATOR INTERNATIONAL;
Dr J. K. Danmbaezue.
Prologue:
IN ENGLISH LANGUAGE
We are here to serve! We are here to
save lives. We are poised to re-invent the pristine priniciples of “being
our brothers and sisters keepers”. That is our motivation! It's our
priority to work closely with the community we live in and earn our living so
as to create a mutually beneficial local relationship while providing the
necessary resources to expand essential healthcare services, professional
care and technology. It has been the ultimate objective of this team of
dedicated research scientists to have a holistic perspective of health both
in theory and in practice. Thus we started off the first TRIPARTITE
CONSULTATIONS in world history, whereby a patient is seen contemporaneously
by three specialists in the triangular prism of health care delivery, viz:
the PHYSICAL. SOCIAL and MENTAL dimensions or levels of optimum
health that each person is entitled to. It may be difficult to attain, but
we have been doing it for a decade now. All it costs us is HUMANITARIAN
PRINCIPLES that ignore capitalist orientations. We are doctors without
borders; no social class nor religious compartmentalisation is our motto!
A single voice can change the world.
Whether the voice describes a new scientific theory, tells the stories of a
culture or speaks for a previously voiceless group of people, it can reach
across national borders and across time to influence a wider world and
transform the world that follows. The 20th century is nearing an end. Great
changes have occurred in the past 100 years, so that science, art, politics
and society, as they approach the year 2000, are markedly different than
they were in 1900. Powerful ideas, such as non-violent political protest
and the theory of the unconscious—developed by unique thinkers such as
Mohandas Gandhi of India and Sigmund Freud of Austria—have
altered humanity, increased understanding between individuals and cultures
and helped define our present world. 1]
[1]"Influential
Thinkers of the 20th Century," Microsoft® Encarta® 98 Encyclopedia. ©
1997.
The
voices of all the patriotic health professionals and friends of Dr J. K.
Danmbaezue who are the foundation members of this interdisciplinary team
are being added in this millennium in the areas of Human/Social Medicine
and Psychometrics in finding Alternative Management Strategies for Halting
the pandemic of HIV-AIDS, by Re-education of the Youths through Pre-Marital
counselling and Existential Family Therapeutics. We need your
intellectual, moral and financial support to translate these objectives
into meaningful and practicable programmes to benefit the less-informed
masses that pro-create profusely in the hinterlands of our nations in
Sub-Saharan Africa for now, and later to all the developing nations of the
world!----Danmbaezue J. K. (11th March 2001)
IN
GERMAN LANGUAGE
GESUNDHEIT FÜR KENEZIANS alles was Sie wissen
müssen
ÜBER Gesundheitssysteme weltweit
Die Theorie & Praxis für interdisziplinäre therapeutische Organisation
gegründet von Hafani Research Consortium
Zusammengestellt vom Animator INTERNATIONAL, Dr. JK Danmbaezue.
Prolog:
Wir sind hier um zu dienen! Wir sind hier, um Leben zu
retten. Wir sind bereit, neu zu erfinden, die unberührten priniciples
des "Seins unsere Brüder und Schwestern Hüter". Das ist
unsere Motivation! Es ist unsere Priorität, eng mit der Gemeinde in
der wir leben und unseren Lebensunterhalt verdienen, um so eine für beide
Seiten vorteilhafte Beziehung zu schaffen und gleichzeitig lokale
Bereitstellung der notwendigen Ressourcen, um essentiellen
Gesundheitsdiensten, professionelle Betreuung und Technik zu
erweitern. Es war das Endziel dieses Team von engagierten Forschern,
um eine ganzheitliche Sichtweise von Gesundheit sowohl in Theorie und
Praxis haben. So brachen wir die ersten dreigliedrigen Konsultationen
in der Weltgeschichte, wobei ein Patient gleichzeitig wird durch drei
Fachleute sehen in dem dreieckigen Prisma der Erbringung von
Gesundheitsleistungen, nämlich: die physische. Soziale und mentale
Dimensionen oder Ebenen der optimalen Gesundheit, dass jeder Mensch das Recht
hat,. Es kann schwierig sein zu erreichen, aber wir getan haben, es
für ein Jahrzehnt. Alles was es kostet uns ist, die humanitären
Prinzipien der kapitalistischen Orientierungen zu ignorieren. Wir sind
Ärzte ohne Grenzen, keine soziale Klasse oder religiöse Abschottung ist
unser Motto!
Eine einzige Stimme kann die Welt verändern. Ob die Stimme eine neue wissenschaftliche
Theorie beschreibt, erzählt die Geschichten von einer Kultur oder spricht
für eine zuvor Stimmlosen Gruppe von Menschen, kann es über nationale
Grenzen hinweg und über die Zeit hinweg zu erreichen, eine größere Welt zu
beeinflussen und verwandle die Welt, die folgt. Das 20. Jahrhundert
nähert sich dem Ende. Große Veränderungen haben in den letzten 100
Jahren aufgetreten, so dass Wissenschaft, Kunst, Politik und Gesellschaft,
da sie das Jahr 2000 nähern, deutlich anders, als sie im Jahr 1900 waren
es.Leistungsstarke Ideen, wie gewaltfreien politischen Protests und der
Theorie von der durch einzigartige Denker wie Mohandas Gandhi in Indien und
Sigmund Freud von unbewussten entwickelte Österreich-verändert haben
Menschlichkeit, mehr Verständnis zwischen Menschen und Kulturen und trug
zur Definition unserer heutigen Welt. 1]
[1] "einflussreichsten Denker des 20. Jahrhunderts," Microsoft ®
Encarta ® 98 Encyclopedia. © 1997.
Die Stimmen von allen patriotischen Gesundheitsberufe und Freunde von Dr.
JK Danmbaezue, die die Gründungsmitglieder des interdisziplinären Teams
sind werden in diesem Jahrtausend in den Bereichen Mensch / Sozialmedizin
und Psychometrie bei der Suche nach alternativen Strategien zum Umgang
Eindämmung der Pandemie von HIV hinzugefügt -AIDS, durch Umerziehung
der Jugend durch voreheliche Beratung und Existenzanalyse Familie
Therapeutics.Wir brauchen Ihre geistige, moralische und finanzielle
Unterstützung, um diese Ziele in sinnvolle und praktikable Programme umzusetzen,
die weniger informierten Massen reichlich, dass pro-schaffen sich im
Hinterland von unseren Nationen in Afrika südlich der Sahara für jetzt und
später auf alle Entwicklungsländer profitieren Völker der Welt! ----
Danmbaezue JK (11. März 2001)
IN FRENCH LANGUAGE
LA SANTÉ POUR
KENEZIANS tout ce que vous devez savoir
A PROPOS DE SYSTÈMES DE SANTÉ DANS LE MONDE
La théorie et la pratique de l'Organisation thérapeutique
interdisciplinaire
fondée par Hafani Consortium pour la recherche
Compilé par le INTERNATIONAL ANIMATOR, le Dr JK Danmbaezue.
Prologue:
Nous sommes ici pour servir! Nous sommes ici pour sauver des
vies. Nous sommes prêts à ré-inventer les priniciples vierges d
'"être nos frères et sœurs gardiens". C'est notre
motivation! C'est notre priorité est de travailler en étroite
collaboration avec la communauté où nous vivons et gagner notre vie de
manière à créer une relation mutuellement bénéfique locale tout en
fournissant les ressources nécessaires pour étendre les services de soins
de santé essentiels, les soins professionnels et de la technologie. Il
a été l'objectif ultime de cette équipe de chercheurs dédiés d'avoir une
perspective holistique de la santé à la fois en théorie et en
pratique. Ainsi nous avons commencé les premières consultations
tripartites dans l'histoire du monde, par lequel un patient est vu
simultanément par trois spécialistes dans le prisme triangulaire de la
prestation des soins de santé, à savoir: le physique. Les dimensions
sociales et mentale ou leur niveau de santé optimal que chaque personne a
droit. Il peut être difficile à atteindre, mais nous avons fait
pendant une décennie maintenant. Tout ce qu'il nous en coûte est
principes humanitaires qui ne tiennent pas compte des orientations capitalistes. Nous
sommes des médecins sans frontières, pas de classe sociale ni de
cloisonnement religieux est notre devise!
Une seule voix peut changer le monde. Que ce soit la voix décrit une
nouvelle théorie scientifique, raconte les histoires d'une culture ou parle
pour un groupe déjà sans voix de personnes, il peut atteindre à travers les
frontières nationales et dans le temps d'influencer un monde plus vaste et
transformer le monde qui suit.Le 20ème siècle touche à sa fin. De
grands changements ont eu lieu dans les 100 dernières années, de sorte que
la science, l'art, la politique et la société, à mesure qu'ils approchent
de l'année 2000, sont nettement différents de ce qu'ils étaient en
1900. Idées puissantes, telles que la non-violente de protestation
politique et la théorie de l'humanité inconscient élaborée par des penseurs
uniques tels que Mohandas Gandhi de l'Inde et Sigmund Freud de
l'Autriche-ont modifié, une meilleure compréhension entre les individus et
les cultures et a aidé à définir notre monde actuel. 1]
[1] «penseurs les plus influents du 20e siècle," Microsoft ® Encarta ®
98 Encyclopédie. © 1997.
Les voix de tous les professionnels de la santé patriotiques et les amis du
Dr JK Danmbaezue qui sont les membres de la fondation de cette équipe
interdisciplinaire sont ajoutés dans ce nouveau millénaire dans les
domaines de la médecine humaine / sociale et de la psychométrie à trouver
des stratégies de gestion alternatives pour mettre un terme à la pandémie
du VIH -SIDA, par Re-éducation des jeunes par le biais consultation
prénuptiale et de thérapeutique de famille existentiels. Nous avons
besoin de votre soutien intellectuel, moral et financier de traduire ces
objectifs dans les programmes significatifs et possible de bénéficier des
masses moins informés que les pro-créer en abondance dans les arrière-pays
de nos nations en Afrique sub-saharienne pour l'instant, et plus tard à
tous les pays en développement nations du monde! ---- Danmbaezue JK
(11 Mars 2001)
IN SPANISH LANGUAGE
SALUD PARA
KENEZIANS todo lo que necesitas saber
ACERCA DE LA SALUD SISTEMAS DE TODO EL MUNDO
La Teoría y Práctica de la Organización Terapéutico Interdisciplinario
fundada por el Consorcio de Investigación Hafani
Compilado por el animador INTERNACIONAL, Dr. JK Danmbaezue.
Prólogo:
Estamos aquí para servirle! Estamos aquí para salvar
vidas. Estamos a punto de volver a inventar las priniciples prístinas
de nuestro ser "hermanos y hermanas" guardianes. Esa es
nuestra motivación! Es nuestra prioridad trabajar en estrecha colaboración
con la comunidad en que vivimos y nos ganamos la vida con el fin de crear
una relación mutuamente beneficiosa, mientras que local, proporcionando los
recursos necesarios para ampliar los servicios esenciales de salud,
atención profesional y la tecnología. Ha sido el objetivo fundamental
de este equipo de científicos de investigación dedicados a tener una
perspectiva holística de la salud tanto en la teoría y en la
práctica. Por lo tanto, estamos trabajando en las primeras consultas
tripartitas en la historia del mundo, con lo que se ve a un paciente
simultáneamente por tres especialistas en el prisma triangular de la
asistencia sanitaria, a saber: el físico. Dimensiones Sociales y
Mentales o del nivel de salud óptimo que cada persona tiene derecho. Puede
ser difícil de lograr, pero hemos estado haciendo desde hace una
década. Todo lo que nos cuesta es principios humanitarios que ignoran
las orientaciones capitalistas. Somos médicos sin fronteras, no hay
clase social ni religiosa compartimentación es nuestro lema!
Una sola voz puede cambiar el mundo. Ya sea que la voz describe una
nueva teoría científica, cuenta la historia de una cultura o habla por un
grupo hasta ahora sin voz de la gente, puede llegar a través de las
fronteras nacionales ya través del tiempo para influir en un mundo más
amplio y transformar el mundo que le sigue. El siglo 20 está llegando
a su fin. Grandes cambios han ocurrido en los últimos 100 años, por lo
que la ciencia, el arte, la política y la sociedad, cuando se acercan al
año 2000, son notablemente diferentes de lo que eran en 1900.Ideas
poderosas, como la no-violenta protesta política y la teoría de la
humanidad inconsciente, desarrollada por pensadores únicos como Mohandas
Gandhi de la India y Sigmund Freud de Austria-han alterado, el aumento de
la comprensión entre los individuos y las culturas y ayudó a definir
nuestro mundo actual. 1]
[1] "Los pensadores influyentes del siglo 20", Microsoft ®
Encarta ® Encyclopedia 98. © 1997.
Las voces de todos los profesionales de la salud patrióticos y amigos del
Dr. JK Danmbaezue que son los miembros de la fundación de este equipo
interdisciplinario se están agregando en este milenio en las áreas de
Medicina Humana / Social y Psicometría en la búsqueda de estrategias de
tratamiento para detener la pandemia del VIH -sida, por Re-educación
de los jóvenes a través de consejería pre-matrimonial y Terapéutica
existenciales de Familia.Necesitamos su apoyo intelectual, moral y
financiero para traducir estos objetivos en los programas de útiles y viables,
para beneficiar a las masas menos informadas que los pro-crear con
profusión en las zonas de influencia de nuestras naciones en el África
subsahariana, por ahora, y más tarde a todos los países en
desarrollo las naciones del mundo! ---- Danmbaezue JK (11 de marzo de
2001)
IN JAPANES LANGUAGE
KENEZIANSあなたが知っているために必要なすべての健康
Worldwideについて医療制度
学際的な治療機関の理論と実践
Hafani研究コンソーシアムによって設立された
ANIMATOR INTERNATIONALによってコンパイルされた。博士JK Danmbaezue。
プロローグ：
我々は、提供するためにここにいます！私たちは命を救うためにここにある。私たちは "である私たちの兄弟姉妹キーパー"の原始的なpriniciplesの再発明をする態勢を整えています。私たちの動機はそれです！それは我々が住んでいる地域と密接に連携し、必要不可欠な医療サービス、専門的ケアと技術を展開するために必要なリソースを提供しながら、相互に有益な地元の関係を作成するために、私たちの生活費を稼ぐために私たちの優先順位です。それは理論と実践の両方の健康の全体的な視点を持つように専用の研究者のこのチームの究極の目標であった。物理的：したがって、私たちは、患者が医療提供、すなわち三角プリズムの3つの専門家によって同時期に見られていることにより、世界史上初の三者協議を始めました。それぞれの人が受ける権利を有することが最適な健康の社会的および精神的な寸法やレベル。それは達成することは困難かもしれませんが、我々は今、十年のためにそれをやっている。それが我々のコストはすべて資本主義の方向を無視して人道原則である。我々は、国境なき医師団であり、社会階級や宗教的なコンパートメントには私たちのモットーではありません！
単一の声が世界を変えることができます。声は、新しい科学理論を説明する文化の物語を伝えたり、人々の以前に無声グループのために話すかどうか、それはより広い世界に影響を与えると、次の世界を変えるために国境を越えてと時間を越えて到達することができます。 20世紀は終わりに近づいています。大きな変化は、科学、芸術、政治や社会は、彼らが2000年に近づくにつれ、彼らは1900年にあったより著しく異なっているように、過去100年間に発生した。このような非暴力的な政治的な抗議と無意識の開発、インドのマハトマ·ガンジーとオーストリア持っている変更され、人類のジークムント·フロイトのようなユニークな思想家の理論のような強力なアイデアは、個人や文化間の理解を増加し、現在の我々の世界を定義しました。 1]
[1] "20世紀の影響力のある思想家は、"
Microsoft®Encarta百科®98百科事典。©1997。
この学際的なチームの基礎のメンバーである博士JK
Danmbaezueのすべての愛国的な医療専門家や友人の声は、HIVの流行を停止するための代替の経営戦略を見つけるために人間/社会医学と心理統計学の分野では、このミレニアムに追加されています-AIDS、婚前カウンセリングと実存家族の治療を通じて、青少年の再教育による。我々は、今のサハラ以南のアフリカにおける私たちの国の奥地にやたらとプロ作成することの少ない情報に大衆の利益のために有意義かつ実用的なプログラムにこれらの目標を変換するために、知的、道徳的及び財政的支援を必要とし、以降のすべての開発へ世界の国！---- Danmbaezue
JK（2001年3月11日）
A single voice can change the world. Whether the voice
describes a new scientific theory, tells the stories of a culture or speaks
for a previously voiceless group of people, it can reach across national
borders and across time to influence a wider world and transform the world
that follows. The 20th century is nearing an end. Great changes have
occurred in the past 100 years, so that science, art, politics and society,
as they approach the year 2000, are markedly different than they were in
1900. Powerful ideas, such as non-violent political protest and the theory
of the unconscious—developed by unique thinkers such as Mohandas Gandhi of India and Sigmund Freud of Austria—have altered humanity, increased
understanding between individuals and cultures and helped define our
present world. 1]
[1]"Influential
Thinkers of the 20th Century," Microsoft® Encarta® 98 Encyclopedia. ©
1997.
The voices of all the patriotic health
professionals and friends of Dr J. K. Danmbaezue who are the foundation
members of this interdisciplinary team are being added in this millennium
in the areas of Human/Social Medicine and Psychometrics in finding
Alternative Management Strategies for Halting the pandemic of HIV-AIDS, by
Re-education of the Youths through Pre-Marital counselling and
Existential Family Therapeutics. We need your intellectual, moral and
financial support to translate these objectives into meaningful and
practicable programme to benefit the less-informed masses that pro-create
profusely in the hinterlands of our nations in Sub-Saharan Africa for now,
and later to all the developing nations of the
world!-----------------------------------------------------------------------------------------------------Danmbaezue J. K. (11th March 2001)
HERE ARE THE TOPICS THAT FORM THE
FOUNDATION STONES OF ALL OUR RESEARCH THEMES, READINGS & PROJECTS
From Wikipedia, the free encyclopedia
Health For All is a programming goal of the World Health
Organization (WHO), which envisions securing the health and
well being of people around the world that has been popularized since the
1970s. It is the basis for the World Health Organization's primary health care strategy
to promote health,
human dignity, and enhanced quality of life.
Halfdan Mahler,
Director General (1973-1983) of the WHO, defined Health For All in 1981, as
follows:[1]
Health For All means that health is to be brought within reach of
everyone in a given country. And by "health" is meant a personal
state of well being, not just the availability of health services – a state
of health that enables a person to lead a socially and economically
productive life. Health For All implies the removal of the obstacles to
health – that is to say, the elimination of malnutrition, ignorance, contaminated drinking water and unhygienic housing
– quite as much as it does the solution of pus a lack of doctors, hospital
beds, drugs and vaccines.
· Health For All
means that health should be regarded as an objective of economic
development and not merely as one of the means of attaining
it.
· Health For All
demands, ultimately, literacy for
all. Until this becomes reality it demands at least the beginning of an
understanding of what health means for every individual.
· Health For All
depends on continued progress in medical care and public health. The health services must be
accessible to all through primary health care,
in which basic medical help is available in every village, backed up by
referral services to more specialised care. Immunisation must similarly achieve
universal coverage.
· Health For All is
thus a holistic concept calling for efforts in agriculture, industry, education, housing,
and communications,
just as much as in medicine and public health. Medical care alone cannot
bring health to in hovels. Health for such people requires a whole new way
of life and fresh opportunities to provide themselves with a higher
standard of living.
The adoption of Health For All by government, implies a commitment
to promote the advancement of all citizens on a broad front of development
and a resolution to encourage the individual citizen to achieve a higher
quality of life. The rate of progress will depend on the political will.
The World Health
Assembly believes that, given a high degree of
determination, Health For All could be attained by the year 2000. That
target date is a challenge to all WHO's Member States. The basis of the
Health For All strategy is primary health care.
Health for all became the slogan for a movement. It was not just an
ideal but an organizing principle: everybody needs and is entitled to the
highest possible standard of health. The principles remain indispensable
for a coherent vision of global health. Turning that vision into
reality calls for clarity both on the possibilities and on the obstacles
that have slowed and in some cases reversed progress towards meeting the
health needs of all people. We have a real opportunity now to make progress
that will mean longer, healthier lives for millions of people, turn despair
into realistic hope, and lay the foundations for improved health for
generations to come.
From Wikipedia, the free encyclopedia
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.
There is a wide variety of health systems around the world, with as
many histories and organizational structures as there are nations. In some
countries, health system planning is distributed among market participants.
In others, there is a concerted effort among governments, trade unions, charities,
religious, 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.[1][2]
The goals for health systems, according to the World Health
Organization, are good health, responsiveness to the
expectations of the population, and fair financial contribution. Progress
towards them depends on how systems carry out four vital functions: provision of
health care services, resource generation, financing, and
stewardship.[3] Other dimensions for the
evaluation of health systems include quality, efficiency, acceptability,
and equity.[1] They have also been
described in the United States as "the five C's": Cost, Coverage,
Consistency, Complexity, and Chronic Illness.[4] Also, continuity of
health care is a major goal.[5]
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[6] 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."[6]
[edit] World Health Organization
Definition
The World Health
Organization defines health system 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."[7]
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, paramedics, dentists, medical
laboratory technologists, therapists, psychologists, pharmacists, chiropractors, optometrists, community
health workers, traditional medicine practitioners, and others.
[edit] Financial
resources
There are generally five primary methods of funding health systems:[8]
- 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 [9] 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.[10]
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, or negotiating standard fees with
the medical profession. 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.[11]
In most countries, wage costs for
health care practitioners are estimated to represent between 65% and 80% of
renewable health system expenditures.[12][13] There are three ways to
pay medical practitioners: fee for service, capitation, and salary. There
has been growing interest in blending elements of these systems.[14]
There are two ways to set fee levels:[14]
- By
individual practitioners.
- Central
negotiations (as in Japan, Germany, Canada and in France) or hybrid
model (such as in Australia, France's sector 2, and New Zealand) where
GPs can charge extra fees on top of standardized patient reimbursement
rates.
In capitation
payment systems, GPs are paid for each patient on their
"list", usually with adjustments for factors such as age and
gender.[14] 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."[14]
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."[14]
[edit] Salary
arrangements
In several OECD countries, general practitioners (GPs) are employed
on salaries for the government.[14] 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."[14] There has been movement
away from this system.[14]
[edit] Information
resources
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.[15] Another major public
health concern is diabetes.[16] 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.[17]
[edit] 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[18].
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[19] including human resources development[20] using standard
definitions, indicators and measures.
[edit] International
comparisons
Health systems may vary substantially from countries to countries,
and in the last years comparisons have been made on an international basis.
The World Health
Organization, in its World Health
Report 2000, provided a ranking of health systems around the
world according to criteria of the overall level and distribution of health in the populations, and the
responsiveness and fair financing of health care services.[3] The goals for health
systems, according to the WHO's World Health Report 2000 - Health
systems: improving performance (WHO, 2000)[21], are good health,
responsiveness to the expectations of the population, and fair financial
contribution. There have been several debates around the results of this
WHO exercise,[22] and especially based on
the country ranking linked to
it,[23] insofar as it appeared to
depend mostly on the choice of the retained indicators.
Direct comparisons of health statistics across nations are complex.
The Commonwealth Fund,
in its annual survey, "Mirror, Mirror on the Wall", compares the
performance of the health systems in Australia, New Zealand, the United
Kingdom, Germany, Canada and the U.S. Its 2007 study found that, although
the U.S. system is the most expensive, it consistently underperforms
compared to the other countries.[24] A major difference between
the U.S. and the other countries in the study is that the U.S. is the only
country without universal health
care. The OECD also collects
comparative statistics, and has published brief country profiles.[25][26][27]
12. ^ Saltman RB, Von Otter C. Implementing
Planned Markets in Health Care: Balancing Social and Economic
Responsibility. Buckingham: Open University Press 1995.
13. ^ Kolehamainen-Aiken RL.
Decentralization and human resources: implications and impact. Human
Resources for Health Development 1997, 2(1):1-14.
18. ^ Handler A, Issel M, Turnock B. A
conceptual framework to measure performance of the public health system. American
Journal of Public Health, 2001, 91(8): 1235-1239.
23. ^ Navarro V. Assessment of the World
Health Report 2000. Lancet 2000; 356: 1598–601
From Wikipedia, the free encyclopedia
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
cambpopulations. 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
wellbeing of peoples 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]
[edit] Health
care delivery
Primary care may be provided in community health centres.
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 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]
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.
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]
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]
[edit] Home
and community care
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.
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.
[edit] Health
care industry
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]
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]
[edit] Health
care research
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]
[edit] Health
care financing
- general taxation to the state, county or
municipality
- social health
insurance
- voluntary
or private health insurance
- out-of-pocket
payments
- 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.
[edit] Health care administration and
regulation
[edit] Health information technology
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.
From Wikipedia, the free encyclopedia
This article is about a sector of the health care system. For the
approach to providing universal health care, see Primary health care.
Primary care may be provided in community health centres.
Primary care is the term for the health services by providers who
act as the principal point of consultation for patients within a health care system.[1][2] Such a professional can be
a primary care
physician, such as a general
practitioner or family physician, or depending on the
locality, health system organization, and patient's discretion, they may
see a pharmacist, a physician assistant,
a nurse practitioner,
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.
The World Health
Organization attributes the provision of essential primary
care as an integral component of an inclusive primary health care strategy.
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, mentaland 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. Collaboration among providers is a desirable characteristic of
primary care.
In context of global population ageing,
with increasing numbers of older adults at greater risk of chonic non-communicable
diseases, rapidly increasing demand for primary care services is
expected around the world, in both developed and developing countries.[4][5]
[edit] Primary
care by country
In Canada, access to primary and other health care services are
guaranteed for all citizens through the Canada Health Act.
In Nigeria, health care is a concurrent responsibility of three
tiers of government. Local governments focus on the delivery of primary
care (e.g. through a system of dispensaries), state governments manage the
various general hospitals (secondary
care), while the federal government's role is mostly limited to
coordinating the affairs of the Federal Medical
Centres and university teaching hospitals (tertiary care).
A 2009 report by the New
England Healthcare Institute determined that an increased
demand on primary care by older, sicker patients and decreased supply of
primary care practitioners has led to a crisis in primary care delivery.
The research identified a set of innovations that could enhance the
quality, efficiency and effectiveness of primary care in the United States.[5]
From Wikipedia, the free encyclopedia
Nations with Universal health care systems (July 2009).
Nations with
some type of universal health care system.
Nations
attempting to obtain universal health care.
Health care
coverage provided by the United States war funding.
Nations with
no universal health care.
Universal health care is a term referring to organized health care systems built
around the principle of universal coverage for all members of society,
combining mechanisms for health financing and service provision.[1]
Germany has the world's oldest universal health care system, with
origins dating back to Otto von Bismarck's social legislation,
which included the Health Insurance Bill of 1883, Accident Insurance Bill
of 1884, and Old Age and Disability Insurance Bill of 1889. In Britain,
the National
Insurance Act 1911 marked the first steps there towards
universal health care, covering most employed persons and their financial
dependents and all persons who had been continuous contributors to the
scheme for at least five years whether they were working or not. This
system of health insurance continued in force until the creation of the National Health
Service in 1948 which extended health care security to all
legal residents. Most current universal health care systems were
implemented in the period
following the Second World War as a process of deliberate health care reform,
intended to make health care available to all, in the spirit of Article 25
of the Universal
Declaration of Human Rights of 1948, signed by every
country doing so. The US did not ratify the social and economic rights sections,
including Article 25's right to health.[2]
[edit] Implementation and comparisons
Health spending per capita, in US$ PPP-adjusted,
amongst various first world nations.
Universal health care systems vary according to the extent of
government involvement in providing care and/or health insurance. In some
countries, such as the UK, Spain, Italy and the Nordic countries, the
government has a high degree of involvement in the commissioning or
delivery of health care services and access is based on residence rights
not on the purchase of insurance. Others have a much more pluralistic
delivery system based on obligatory health with contributory insurance
rates related to salaries or income, and usually funded by employers and
beneficiaries jointly. Sometimes the health funds are derived from a
mixture of insurance premiums, salary related mandatory contributions by
employees and/or employers to regulated sickness funds, and by government
taxes. These insurance based systems tend to reimburse private or public
medical providers, often at heavily regulated rates, through mutual or
publicly owned medical insurers. A few countries such as the Netherlands
and Switzerland operate via privately owned but heavily regulated private
insurers that are not allowed to make a profit from the mandatory element
of insurance but can profit by selling supplemental insurance.
Universal health care is a broad concept that has been implemented
in several ways. The common denominator for all such programs is some form
of government action aimed at extending access to health care as widely as
possible and setting minimum standards. Most implement universal health
care through legislation, regulation and taxation. Legislation and
regulation direct what care must be provided, to whom, and on what basis.
Usually some costs are borne by the patient at the time of consumption but
the bulk of costs come from a combination of compulsory insurance and tax
revenues. Some programs are paid for entirely out of tax revenues. In
others tax revenues are used either to fund insurance for the very poor or
for those needing long term chronic care. The UK government's National
Audit Office in 2003 published an international comparison
of ten different health care systems in ten developed countries, nine
universal systems against one non-universal system (the U.S.), and their
relative costs and key health outcomes.[3] A wider international
comparison of 16 countries, each with universal health care, was published
by the World Health
Organization in 2004[4] In some cases, government
involvement also includes directly managing the health care system,
but many countries use mixed public-private systems to deliver universal
health care.
Argentina,
Barbados, Brazil (see
below), Canada (see
below), Chile, Colombia (see
below), Costa Rica, Cuba, Mexico (see
below), Panama, Peru (see below), Uruguay, Trinidad
and Tobago, and Venezuela all
have public universal health care provided.
Health care is provided through a combination of employer and labor
union-sponsored plans (Obras Sociales), government insurance plans, public
hospitals and clinics and through private health insurance plans. It costs
almost 10% of GDP and is available to anyone regardless of ideology,
beliefs, race or nationality.
The universal health care system was adopted in Brazil in 1988 after
the end of the military regime's rule. However, universalized/socialized
health care was available many years before, in some cities, once the 27th
amendment to the 1969 Constitution imposed the duty of applying 6% of their
income in healthcare on the municipalities.[5]
In 1984, the Canada Health Act was
passed, which prohibited extra billing by doctors on patients while at the
same time billing the public insurance system. In 1999, the prime minister
and most premiers reaffirmed in the Social
Union Framework Agreement that they are committed to health
care that has "comprehensiveness, universality, portability, public
administration and accessibility."[6]
The system is for the most part publicly funded, yet most of the
services are provided by private enterprises or private corporations,
although most hospitals are public. Most doctors do not receive an annual
salary, but receive a fee per visit or service.[7] About 29% of Canadians'
health care is paid for by the private sector or individuals.[8] This mostly goes towards
services not covered or only partially covered by Medicare such
as prescription drugs, dentistry and vision care.[9] Many Canadians have private
health insurance, often through their employers, that cover these expenses.[10]
The Canada Health Act of 1984 "does not directly bar private
delivery or private insurance for publicly insured services," but
provides financial disincentives for doing so. "Although there are
laws prohibiting or curtailing private health care in some provinces, they
can be changed," according to a report in the New
England Journal of Medicine.[11][12] The legality of the ban
was considered in a decision of the Supreme Court
of Canada which ruled in Chaoulli v. Quebec that
"the prohibition on obtaining private health insurance, while it might
be constitutional in circumstances where health care services are
reasonable as to both quality and timeliness, is not constitutional where
the public system fails to deliver reasonable services." The appellant contended that waiting
times in Quebec violated a right to life and security in the Quebec Charter of Human Rights and Freedoms. The Court
agreed, but acknowledged the importance and validity of the Canada Health
Act, and at least four of the seven judges explicitly recognized the right
of governments to enact laws and policies which favour the public over the
private system and preserve the integrity of the public system.
Health care in Chile is provided by the government (via Fonasa) and
by private insurers (via Isapre). All workers and pensioners are mandated
to pay 7% of their income for health care insurance (the poorest pensioners
are exempt from this payment). Workers who choose not to join an Isapre,
are automatically covered by Fonasa. Fonasa also covers unemployed people
receiving unemployment benefits, uninsured pregnant women, insured worker's
dependant family, people with mental or physical disabilities and people
who are considered poor or indigent.
Fonasa costs vary depending on income, disability or age. Attention
at public health facilities via Fonasa is free for low-income earners,
people with mental or physical disabilities and people over the age of 60.
Others pay 10% or 20% of the costs, depending on income and number of
dependants. Fonasa beneficiaries may also seek attention in the private
sector, for a designated fee.
Additionally, there are a number of high-mortality illnesses
(currently 69) that have special attention guarantees for both Isapre and
Fonasa affiliates, in relation to access to treatment, waiting times,
maximum costs and quality of service.
In 1993 a reform transformed the health care system in
Colombia, trying to provide a better, sustainable, health care system and
to reach every Colombian citizen.
Public health care delivery is accomplished via an elaborate
provisioning and delivery system instituted by the Mexican Federal
Government. Public health care is provided to all Mexican citizens as
guaranteed via Article 4 of the Constitution. Public care is either fully
or partially subsidized by the federal government, depending on the
person's (Spanish: derechohabiente's) employment status. All Mexican
citizens are eligible for subsidized health care regardless of their work
status via a system of health care facilities operating under the federal
Secretariat of Health (formerly the Secretaria de Salubridad y Asistencia,
or SSA) agency. Employed citizens and their dependents, however, are
further eligible to use the health care program administered and operated
by the Instituto Mexicano del Seguro Social (IMSS) (English: Mexican Social
Security Institute). The IMSS health care program is a tripartite system
funded equally by the employee, its private employer, and the federal
government. The IMSS does not provide service to employees of the public
sector. Employees in the public sector are serviced by the Instituto de
Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE)
(English: Institute for Social Security and Services for State Workers),
which attends to the health and social care needs of government employees.
This includes local, state, and federal government employees. The
government of the states in Mexico also provide health services
independently of those services provided by the federal government
programs. In most states, the state government has established free or
subsidized healthcare to all their citizens.
On December 1, 2006 the Mexican government created the Health
Insurance for a New Generation also known as "life insurance for
babies".[13][14][15]
On May 16, 2009 Mexico to Achieve Universal Health Coverage by 2011.[16]
On May 28, 2009 Mexico announced Universal Care Coverage for
Pregnant Women.[17]
On April 10, 2009 the Government of Peru published the Law on Health
Insurance to enable all Peruvians to access quality health services, and
contribute to regulate the financing and supervision of these services. The
law enables all population to access diverse health services to prevent illnesses,
and promote and rehabilitate people, under a Health Basic Plan (PEAS).[18][19]
On April 2, 2010 President Alan Garcia Perez on Friday signed a
supreme ordinance approving the regulations for the framework law on the
Universal Health Insurance, which seeks to provide access to quality health
care for all Peruvian citizens.
Peru’s Universal Health Insurance law aims to increase access to
timely and quality health care services, emphasizes maternal and child
health promotion, and provides the poor with protection from financial ruin
due to illness.[20]
The regulation states that membership of the Universal Health
Insurance (AUS for its Spanish acronym) is compulsory for the entire
population living in the country. To that end, the Ministry of Health will
approve, by supreme ordinance, the mechanisms leading to compulsory
membership, as well as escalation and implementation.[21]
[edit] Trinidad
and Tobago
A universal health care system is used in Trinidad and Tobago and is
the primary form of health-care available in the country. It is used by the
majority of the population seeking medical assistance, as it is free for
all citizens.
The Congressional
Budget Office and related government agencies scored the
cost of a universal health care system several times since 1991, and have
uniformly predicted cost savings,[25] partly from the
elimination of insurance company overhead costs.[26] In 2009, a universal
health care proposal was pending in Congress, the United
States National Health Care Act (H.R. 676, formerly the
"Medicare for All Act").
The Congressional
Budget Office estimated that the bill would reduce the
number of nonelderly people who are uninsured by about 32 million, leaving
about 23 million nonelderly residents uninsured (about one-third of whom
would be illegal immigrants). Under the legislation, the share of legal
nonelderly residents with insurance coverage would rise from about 83
percent in 2010 to about 94 percent by 2019.[27]
In May of 2011, the state of Vermont became the first state to pass
legislation establishing a Single-Payer health care system. The
legislation, known as Act 48, establishes health care in the
state as a "human right" and lays the responsibility on the state
to provide a health care system which best meets the needs of the citizens
of Vermont. The state is currently in the studying phase of how best to
implement this system.
Azerbaijan,[28] Bhutan (see below),
Bahrain,[29] Brunei, China, Hong Kong (see below), India (see
below), Iran,[30] Israel[31] (see below), Japan,
Jordan,[32] Kazakhstan,[33] Kuwait[citation
needed], Macau(see below), Malaysia[citation
needed], Mongolia,[34] North Korea, Oman,[35][36] Pakistan[citation
needed], Qatar[citation
needed], Saudi Arabia[citation
needed], Singapore (see
below), South Korea, Sri Lanka,[37]Syria,[38] Taiwan (R.O.C.)[39] (see below), Tajikistan,[40] Thailand (see below),
Turkey,[41] Turkmenistan,[42] and UAE[citation
needed] have universal health care.
The Royal Government of Bhutan maintains a policy of free and
universal access to primary health care. As hospital facilities in the
country are limited, patients with diseases that cannot be treated in
Bhutan, such as cancer, are normally referred to hospitals in India for
treatment. Such referral treatment is also carried out at the cost of the
Royal Government.[43]
Hong Kong is one of the healthiest places in the world.[citation
needed] Because of its early health education,
professional health services, and well-developed health care and medication
system, Hongkongers enjoy
a life expectancy of
84 for females and 78 for males,[44] which is the second
highest in the world, and 2.94 infant mortality rate, the fourth lowest in
the world.[45][46]
There are two medical schools in Hong Kong, and several schools
offering courses in traditional
Chinese medicine. The Hospital Authority is
a statutory body that operates and manages all public hospitals. Hong Kong
has high standards of medical practice. It has contributed to the
development of liver
transplantation, being the first in the world to carry out an
adult to adult live donor liver transplant in 1993.[47]
India has a universal health care system run by the local (state or
territorial) governments. Government hospitals provide treatment at
taxpayer expense. Some essential drugs are offered free of charge in these
hospitals. However, the fact that the government sector is understaffed,
underfinanced and that these hospitals maintain very poor standards of hygiene
forces many people to visit private medical practitioners.[citation
needed]
An outpatient card at AIIMS (one of the best hospitals in
India) costs a one-time fee of 10 rupees (around 20 cents U.S.) and
thereafter outpatient medical advice is free. In-hospital treatment costs
depend on the financial condition of the patient and the facilities
utilized, but are usually much less than the private sector. For instance,
a patient is waived treatment costs if their income is below the poverty
line. However, getting treatment at high quality government hospitals is
very tough due to the high number of people needing healthcare and the lack
of sufficient facilities.
Primary health care is provided by city and district hospitals and
rural primary health centres (PHCs). These hospitals provide treatment free
of cost, but only if they are functional. Primary care is focused on
immunization, prevention of malnutrition, pregnancy, child birth, postnatal
care, and treatment of common illnesses.[citation
needed] Patients who receive specialized care or
have complicated illnesses are referred to secondary (often located in district and taluk headquarters) and tertiary care
hospitals (located in district and state headquarters or those that are
teaching hospitals).[citation
needed]
Now organizations like Hindustan Latex Family Planning Promotional
Trust and other private organizations have started creating hospitals and
clinics in India, which also provide free or subsidized health care and
subsidized insurance plans.[citation
needed]
The government-run healthcare suffers from a lack of hygiene; the
rich avoid the government hospitals and go to developed countries for
treatment. With the advent of privatized healthcare, this situation has
changed. India now has medical tourism for people from other countries
while its own poor find quality healthcare either inaccessible or
unaffordable.
Health care in Israel as a percentage of GDP
In Israel, the National Health Insurance Law (or National
Health Insurance Act) is the legal framework which enables and
facilitates basic, compulsory universal health care. The Law was put into
effect by the Knesset on
January 1, 1995, and was based on recommendations put forward by a National
Committee of Inquiry headed by Shoshana Netanyahu which
examined restructuring the health care system in Israel in the late 1980s.
Prior to the law's passage over 90% of the population was already covered
by voluntarily belonging to one of four nation-wide, not-for-profit
sickness funds which operated some of their own medical facilities and were
funded in part by employers and the government and in part by the insured
by levies which varied according to income. However, there were three
problems associated with this arrangement. First, membership in the largest
fund, Clalit, required one to belong to the Histadrut labor organization, even if
a person did not wish to (or could not) have such an affiliation while
other funds restricted entry to new members based on age, pre-existing
conditions or other factors. Second, different funds provided different
levels of benefit coverage or services to their members and lastly was the issue
mentioned above whereby a certain percentage of the population, albeit a
small one, did not have health insurance coverage at all.
Before the law went into effect, all the funds collected premiums
directly from members. However, upon passage of the law, a new progressive
national health insurance tax was levied through Israel's social security agency which then
re-distributes the proceeds to the sickness funds based on their membership
and its demographic makeup. This ensured that all citizens
would now have health coverage. While membership in one of the funds now
became compulsory for all, free choice was introduced into movement of
members between funds (a change is allowed once every six months),
effectively making the various sickness funds compete equally for members
among the populace. Annually, a committee appointed by the ministry of
health publishes a "basket" or uniform package of medical
services and prescription formulary which
all funds must provide as a minimum service to all their members. Achieving
this level of equality ensured that all citizens are guaranteed to receive
basic healthcare regardless of their fund affiliation which was one of the
principal aims of the law. An appeals process was put in place to handle
rejection of treatments and procedures by the funds and evaluating cases
falling outside the "basket" of services or prescription
formulary.
While the law is generally considered a success and Israeli citizens
enjoy a high standard of medical care comparatively, with more competition
having been introduced into the field of health care in the country, and
order having been brought into what was once a somewhat disorganized
system, the law nevertheless does have its critics. First and foremost
among the criticisms raised is that the "basket" may not provide
enough coverage. To partly address this issue, the HMOs and insurance
companies began offering additional "supplementary" insurance to
cover certain additional services not included in the basket. However,
since this insurance is optional (though usually very modestly priced,
costing the equivalent of about US$10 to $20 a month), critics argue that
it goes against the spirit of the new law which stressed equality among all
citizens with respect to healthcare. Another criticism is that in order to
provide universal coverage to all, the tax income base amount (the maximum
amount of yearly earnings that are subject to the tax) was set rather high,
causing many high-income taxpayers to see the amount they pay for their
health premiums (now health tax) skyrocket. Finally, some complain about
the constantly rising costs of copayments for certain services.
Macau offers universally accessible single-payer system funded by
taxes. Health care is provided by the Bureau for Health.
[edit] People's
Republic of China
Since the founding of the People's Republic of China, the goal of
health care programs has been to provide care to every member of the
population and to make maximum use of limited health-care personnel,
equipment, and financial resources.[citation
needed]
China is undertaking a reform on its health care system, which was
largely privatized in the 1990s. The New Rural Co-operative Medical Care
System (NRCMCS), is a new 2005 initiative to overhaul the healthcare
system, particularly intended to make it more affordable for the rural
poor. Under the NRCMCS, the annual cost of medical cover is 50 yuan (US$7)
per person. Of that, 20 yuan is paid in by the central government, 20 yuan
by the provincial government and a contribution of 10 yuan is made by the
patient. As of September 2007, around 80% of the whole rural population of
China had signed up (about 685 million people). The system is tiered,
depending on the location. If patients go to a small hospital or clinic in
their local town, the scheme will cover from 70–80% of their bill. If they
go to a county one, the percentage of the cost being covered falls to about
60%. And if they need specialist help in a large modern city hospital, they
have to bear most of the cost themselves, the scheme would cover about 30%
of the bill.[48]
On January 21, 2009, the Chinese government announced that a total
of 850 billion yuan (US$ 127.5 billion) will be provided between 2009 and 2011
in order to improve the existing health care system.[49]
Singapore has a universal health care system where government
ensures affordability, largely through compulsory savings and price
controls, while the private sector provides most care. Overall spending on
health care amounts to only 3% of annual GDP. Of that, 66% comes from
private sources.[50] Singapore currently has
the second lowest infant mortality rate in the world and among the highest
life expectancies from birth, according to the World Health
Organization.[51] Singapore has "one of
the most successful healthcare systems in the world, in terms of both
efficiency in financing and the results achieved in community health
outcomes," according to an analysis by global consulting firm Watson Wyatt.[52] Singapore's system uses a
combination of compulsory savings from payroll deductions (funded by both
employers and workers) a nationalized health insurance plan, and government
subsidies, as well as "actively regulating the supply and prices of
healthcare services in the country" to keep costs in check; the specific
features have been described as potentially a "very difficult system
to replicate in many other countries." Many Singaporeans also have
supplemental private health insurance (often provided by employers) for
services not covered by the government's programs.[52]
[edit] Republic
of China (Taiwan)
The current health care system in Taiwan, known as National Health
Insurance (NHI), was instituted in 1995. NHI is a single-payer compulsory
social insurance plan which centralizes the disbursement of health care
dollars. The system promises equal access to health care for all citizens,
and the population coverage had reached 99% by the end of 2004.[53] NHI is mainly financed
through premiums, which are based on the payroll tax, and is supplemented
with out-of-pocket payments and direct government funding. In the initial
stage, fee-for-service predominated for both public and private providers.
NHI delivers universal coverage offered by a government-run insurer.
The working population pays premiums split with their employers, others pay
a flat rate with government help and the poor or veterans are fully
subsidized. Taiwan’s citizens no longer have to worry about going bankrupt
due to medical bills.[54]
Under this model, citizens have free range to choose hospitals and
physicians without using a gatekeeper and do not have to worry about
waiting lists. NHI offers a comprehensive benefit package that covers
preventive medical services, prescription drugs, dental services, Chinese medicine,
home nurse visits and many more. Working people do not have to worry about
losing their jobs or changing jobs because they will not lose their
insurance. Since NHI, the previously uninsured have increased their usage
of medical services. Most preventive services are free such as annual
checkups and maternal and child care. Regular office visits have
co-payments as low as US $5 per visit. Co-payments are fixed and unvaried
by the person’s income.[55]
Thailand introduced universal coverage reforms in 2001, becoming one
of only a handful of lower-middle income countries to do so at the time.
Means-tested health care for low income households was replaced by a new
and more comprehensive insurance scheme, originally known as the 30 baht
project, in line with the small co-payment charged for treatment. People
joining the scheme receive a gold card which allows them to access services
in their health district, and, if necessary, be referred for specialist
treatment elsewhere. The bulk of finance comes from public revenues, with
funding allocated to Contracting Units for Primary Care annually on a
population basis. According to the WHO, 65% of Thailand's health care
expenditure in 2004 came from the government, 35% was from private sources.[50] Although the reforms have
received a good deal of critical comment, they have proved popular with
poorer Thais, especially in rural areas, and survived the change of
government after the 2006 military coup. The then Public Health Minister,
Mongkol Na Songkhla, abolished the 30 baht co-payment and made the UC
scheme free. It is not yet clear whether the scheme will be modified
further under the coalition government that came to power in January 2008.[56][57][58]
Virtually all of Europe has either publicly sponsored and regulated
universal health care or publicly provided universal healthcare. The public
plans in some countries provide basic or "sick" coverage only;
their citizens can purchase supplemental insurance for additional coverage.
Countries with universal health care include Austria, Andorra, Belarus,[59] Belgium, Bosnia and
Herzegovina, Bulgaria, Croatia, the Czech Republic, Denmark, Estonia,
Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland,
Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Moldova,[60] Monaco, the Netherlands,
Norway, Poland, Portugal,[61] Romania, Russia, San
Marino, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Ukraine,[62] and the United Kingdom.[63]
Denmark has a universal public health system paid largely from
taxation with local municipalities delivering health care services in the
same way as other Scandinavian countries. Primary care is provided by a
general practitioner service run by private doctors contracting with the
local municipalities with payment on a mixed per capita and fee for service
basis. Most hospitals are run by the municipalities (only 1% of hospital
beds are in the private sector).
In Finland, public medical services at clinics and hospitals are run
by the municipalities (local government) and are funded 76% by taxation,
20% by patients through access charges, and 4% by others. Private provision
is mainly in the primary care sector. There are a few private hospitals.[64] The main hospitals are
either municipally owned (funded from local taxes) or run by the medical
teaching universities (funded jointly by the municipalities and the
national government). According to a survey published by the European
Commission in 2000, Finland's is in the top 4 of EU countries in terms of
satisfaction with their hospital care system: 88% of Finnish respondents
were satisfied compared with the EU average of 41.3%.[65] Finnish health care
expenditures are below the European average.[citation
needed] The private medical sector accounts for
about 14 percent of total health care spending. Only 8% of doctors choose
to work in private practice, and some of these also choose to do some work
in the public sector.[citation
needed]
Taxation funding is partly local and partly nationally based. The
national social insurance institution KELA reimburses
part of patients prescription costs and makes a contribution towards
private medical costs (including dentistry) if they choose to be treated in
the private sector rather than the public sector. Patient access charges
are subject to annual caps. For example GP visits
cost €11 per visit with annual €33 cap; hospital outpatient treatment €22
per visit; a hospital stay, including food, medical care and medicines €26
per 24 hours, or €12 if in a psychiatric hospital. After a patient has
spent €590 per year on public medical services (including prescription
drugs), all treatment and medications thereafter in that year are free.
France has a system of universal health care largely financed by
government through a system of national
health insurance. It is consistently ranked as one of the best
in the world.
Germany has the world's oldest universal health care system, with
origins dating back to Otto von Bismarck's Health
Insurance Act of 1883.[66] As mandatory health
insurance, it originally applied only to low-income workers and certain
government employees, but has gradually expanded to cover the great
majority of the population.[67] The system is
decentralized with private practice physicians providing ambulatory care,
and independent, mostly non-profit hospitals providing the majority of
inpatient care. Approximately 92% of the population is covered by a
'Statutory Health Insurance' plan, which provides a standardized level of
coverage through any one of approximately 1100 public or private sickness
funds. Standard insurance is funded by a combination of employee contributions,
employer contributions and government subsidies on a scale determined by
income level. Higher income workers sometimes choose to pay a tax and opt
out of the standard plan, in favor of 'private' insurance. The latter's
premiums are not linked to income level but instead to health status.[68]
Historically, the level of provider reimbursement for specific
services is determined through negotiations between regional physician's
associations and sickness funds. Since 1976 the government has convened an
annual commission, composed of representatives of business, labor,
physicians, hospitals, and insurance and pharmaceutical industries.[69] The commission takes into
account government policies and makes recommendations to regional
associations with respect to overall expenditure targets. In 1986
expenditure caps were implemented and were tied to the age of the local
population as well as the overall wage increases. Although reimbursement of
providers is on a fee-for-service basis the amount to be reimbursed for
each service is determined retrospectively to ensure that spending targets
are not exceeded. Capitated care, such as that provided by U.S. health
maintenance organizations, has been considered as a cost containment
mechanism but would require consent of regional medical associations, and
has not materialized.[70] Copayments were introduced
in the 1980s in an attempt to prevent overutilization and control costs.
The average length of hospital stay in Germany has decreased in recent
years from 14 days to 9 days, still considerably longer than average stays
in the U.S. (5 to 6 days).[71][72] The difference is partly
driven by the fact that hospital reimbursement is chiefly a function of the
number of hospital days as opposed to procedures or the patient's
diagnosis. Drug costs have increased substantially, rising nearly 60% from
1991 through 2005. Despite attempts to contain costs, overall health care
expenditures rose to 10.7% of GDP in 2005, comparable to other western
European nations, but substantially less than that spent in the U.S.
(nearly 16% of GDP).[73]
The Greek healthcare system has received high rankings by the World Health
Organization, ranked 14th in the overall assessment and 11th in
quality of service in a 2000 report by the WHO.
The medical care system in the Channel Islands is very similar to
that of the UK in that many of the doctors and nurses have been trained
from the UK health perspective. There is universal health care for
residents of the island.[74]
The public health care system of
the Republic of Ireland is governed by the Health Act 2004,[75] which established a new
body to be responsible for providing health and personal social services to
everyone living in Ireland – the Health Service
Executive. The new national health service came into being
officially on January 1, 2005; however the new structures are currently in
the process of being established as the reform programe continues. In
addition to the public-sector, there is also a large private health care
market.
The Isle of Man provides
universal public health coverage to its residents.[76]
Italy has a public health care service for all the residents called
"Servizio Sanitario Nazionale" or SSN (National Health Service)
which is similar to the UK National Health Service. It is publicly run and
funded mostly from taxation: some services requires small co-pays, while
other services (like the emergency medicine and the general doctor) are
completely free of charge. Like the UK, there is a small parallel private
health care system, especially in the field of Dental Medicine.
Luxembourg has universal coverage of population by health insurance
and mandatory dependence insurance.[77]
The Netherlands has a dual-level system. All primary and curative care (i.e. the family doctor
service and hospitals and clinics) is financed from private compulsory
insurance. Long term care for the elderly, the dying, the long term
mentally ill etc. is covered by social insurance funded
from taxation. According to the WHO, the health care system in the
Netherlands was 62% government funded and 38% privately funded as of 2004.[50]
Insurance companies must offer a core universal insurance package
for the universal primary, curative care which includes the cost of all
prescription medicines. They must do this at a fixed price for all. The
same premium is paid whether young or old, healthy or sick. It is illegal
in The Netherlands for insurers to refuse an application for health
insurance, to impose special conditions (e.g. exclusions, deductibles,
co-pays etc., or refuse to fund treatments which a doctor has determined to
be medically necessary). The system is 50% financed from payroll taxes paid
by employers to a fund controlled by the Health regulator. The government
contributes an additional 5% to the regulator's fund. The remaining 45% is
collected as premiums paid by the insured directly to the insurance
company. Some employers negotiate bulk deals with health insurers and some
even pay the employees' premiums as an employment benefit). All insurance
companies receive additional funding from the regulator's fund. The
regulator has sight of the claims made by policyholders and therefore can
redistribute the funds its holds on the basis of relative claims made by
policy holders. Thus insurers with high payouts will receive more from the
regulator than those with low payouts. Thus insurance companies have no
incentive to deter high cost individuals from taking insurance and are
compensated if they have to pay out more than might be expected. Insurance
companies compete with each other on price for the 45% direct premium part
of the funding and try to negotiate deals with hospitals to keep costs low
and quality high. The competition regulator is charged with checking for
abuse of dominant market positions and the creation of cartels that act
against the consumer interests. An insurance regulator ensures that all
basic policies have identical coverage rules so that no person is medically
disadvantaged by his or her choice of insurer.
Hospitals in the Netherlands are also regulated and inspected but
are mostly privately run and not for profit, as are many of the insurance
companies. Patients can choose where they want to be treated and have
access to information on the internet about the performance and waiting
times at each hospital. Patients dissatisfied with their insurer and choice
of hospital can cancel at any time but must make a new agreement with
another insurer.
Insurance companies can offer additional services at extra cost over
and above the universal system laid down by the regulator, e.g. for dental
care. The standard monthly premium for health care paid by individual
adults is about €100 per month. Persons on low incomes can get assistance
from the government if they cannot afford these payments. Children under 18
are insured by the system at no additional cost to them or their families
because the insurance company receives the cost of this from the
regulator's fund. There is a fixed yearly threshold of €165 for each
person, excluding some health categories (like diagnosis and acute care),
as incentive against excessive claims.
Norway has a universal public health system paid largely from
taxation in the same way as other Scandinavian countries. Norway’s entire
population has equal access to health care services. The Norwegian health
care system is government-funded and heavily decentralized. The health care
system in Norway is financed primarily through taxes levied by county
councils and municipalities. There is no dental coverage within the
Norwegian health care plan.
Norway regularly comes top or close to the top of worldwide
healthcare rankings.
According to Article 34 from the Constitution of
Romania, the state is obliged "to guarantee the sheltering
of healthcare". Romania has, theoretically, a fully universal health
care system, which covers up medical check-ups, any surgical interventions,
and any post-operator medical care, as well as free or subsidized medicine
for a range of diseases. The state is also obliged to fund public hospitals
and clinics. Dental care is not funded by the state, although there are
public dental clinics in some hospitals, which treat patients free of
charge. However, due to the budget cuts and bribing, it is estimated that a
third of the medical expenses are, in some cases, supported by the patient [78] Furthermore, Romania
spends, per capita, less than any other EU state on medical care. [79]
Article 41 of the Constitution of the Russian Federation confirms a
citizen's right to state healthcare and medical assistance free of charge.[80] This is achieved through
state compulsory medical insurance (OMS) which is free to Russian citizens,
funded by obligatory medical insurance payments made by companies and
government subsidies.[81][82] Introduction in 1993
reform of new free market providers in addition to the state-run
institutions intended to promote both efficiency and patient choice. A
purchaser-provider split help facilitate the restructuring of care, as
resources would migrate to where there was greatest demand, reduce the
excess capacity in the hospital sector and stimulate the development of
primary care. Russian Prime Minister Vladimir Putin announced a new large
large-scale health care reform in 2011 and pledged to allocate more than
300 billion rubles ($10 billion) in the next few years to improve health
care in the country.[83] He also said that
obligatory medical insurance tax paid by companies will increase from
current 3.1% to 5.1% starting from 2011.[83]
The Constitution of the Republic of Serbia states that it is a right
of every citizen to seek medical assistance free of charge.[84] This is achieved by mutual
contribution to the so called Compulsory Social Healthcare Fund of RZZO
(Republički Zavod za Zdravstveno Osiguranje or National Health Insurance
Institution). The amount of contribution depends on the amount of money the
person is making. During the 1990s, Serbia's healthcare system has been of
a poor quality due to severe underfunding. In the recent years, however,
that has changed and the Serbian government has invested heavily in new
medical infrastructure, completely remodeling existing hospitals and
building two new hospitals in Novi Sad and Kragujevac.
Sweden has a universal public health system paid largely from taxation
in the same way as other Scandinavian countries. Sweden’s entire population
has equal access to health care services. The Swedish health care system is government-funded and
heavily decentralized. The health care system in Sweden is financed
primarily through taxes levied by county councils and municipalities.
Sweden regularly comes top or close to the top of worldwide
healthcare rankings.[85]
Healthcare in Switzerland is universal and is regulated by the
Federal Health Insurance Act of 1994. Basic health insurance is mandatory
for all persons residing in Switzerland (within three months of taking up
residence or being born in the country). Insurers are required to offer
insurance to everyone, regardless of age or medical condition. They are not
allowed to make a profit off this basic insurance, but can on supplemental
plans.[86]
Each of the Countries
of the United Kingdom has a National Health
Service that provides public healthcare to all UK permanent
residents that is free at the point of need and paid for from general
taxation. However private healthcare companies are free to operate
alongside the public one. Since Health is a devolved matter, considerable differences
are developing between the systems in each of the countries.[87]
The NHS
Constitution for England documents, at high level, the
objectives of the NHS, the legal rights and responsibilities of the various
parties (patients, staff, NHS trust boards), and the guiding principles
which govern the service.[88] The NHS constitution makes
it clear that it provides a comprehensive service, available to all
irrespective of age, gender, disability, race, sexual orientation, religion
or belief; that access to NHS services is based on clinical need and not an
individual’s ability to pay; and that care is never refused on unreasonable
grounds. Patient choice in terms of doctor, care, treatments and place of
treatment is an important aspect of the NHS's ambition, and in some cases
patients can elect for treatment in other European countries at the NHS's
expense. Waiting times are low, with most people able to see their primary
care doctor on the same day or the following day[89] and only 36.1% of hospital
admissions are from a waiting list, with the remainder being either
emergencies admitted immediately or else pre-booked admissions or similar
(e.g. child birth).[90] No patient should
experience a delay of more than 18 weeks from initial hospital referral to
final treatment.[91] This includes the time for
all investigative tests and consultations, and two thirds of patients are
currently treated in under 12 weeks.[92]
Although centrally funded there is no large central bureaucracy to
manage it. Responsibility is highly devolved to geographical areas through Strategic
Health Authorities and even more locally through NHS primary care
trusts, NHS hospital trusts and
increasingly to NHS foundation
trusts which are providing even more decentralized services
within the NHS framework, with more decision making taken by local people,
patients and staff. The central government office, the Department of
Health, is not involved in day to day decision making in either the
Strategic Health Authorities or the individual local trusts (primarily
health, hospital or ambulance) or the national specialist trusts such as NHS Blood and
Transplant, but it does lay down general guidelines for them to
follow. Local trusts are accountable to their local populations, whilst
government ministers are accountable to Parliament for the service overall.
The NHS provides, among other things, primary care, in-patient care, long-term healthcare, psychiatric care and treatments, ophthalmology, and dentistry. All treatment is free with the
exception of certain charges for prescriptions, dentistry and ophthalmology
(which themselves are free to children, certain students in full-time
education, the elderly, the unemployed and those on low incomes).
Eighty-nine percent of NHS prescriptions are obtained free of charge,
mostly children, pensioners and pregnant women. Others pay a flat rate of
£7.20,[93] and others may cap their
annual charges. Private health care has continued parallel to the NHS, paid
for largely by private insurance. Private insurance accounts for only 4
percent of health expenditure and covers little more than a tenth of the
population.[94] Private insurers in the UK
only cover acute care from specialists. They do not cover generalist
consultations, pre-existing conditions, medical emergencies, organ
transplants, chronic conditions such as diabetes, or conditions such as
pregnancy or HIV.[95] Most NHS general
practitioners are private doctors who contract to provide NHS services, but
most hospitals are publicly owned and run through NHS Trusts. A few NHS medical services
(such as "surgicentres")
are sub-contracted to private providers[96] as are some non-medical
services (such as catering). Some capital projects such as new hospitals
have been funded through the Private
Finance Initiative, enabling investment without (in the short
term) increasing the public
sector borrowing requirement, because long-term
contractually-obligated PFI spending commitments are not counted as
government liabilities.
Health and Social Care in Northern Ireland is the designation of the
national public health service in Northern Ireland.
In Australia, Medibank — as it was then known — was
introduced, by the Whitlam Labor
government on July 1, 1975, through the Health
Insurance Act 1973. The Australian Senate rejected
the changes multiple times and they were passed only after a joint sitting
after the 1974
double dissolution election. However, Medibank was supported by
the subsequent Fraser Coalition
(Australia)government and became a key feature of Australia’s
public policy landscape. The exact structure of Medibank/Medicare, in terms
of the size of the rebate to doctors and hospitals and the way it has
administered, has varied over the years. The original Medibank program
proposed a 1.35% levy (with low income exemptions) but these bills were
rejected by the Senate, and so Medibank was funded from general taxation.
In 1976, the Fraser Government introduced a 2.5% levy and split Medibank in
two: a universal scheme called Medibank Public and a government-owned
private health insurance company, Medibank Private.
During the 1980s, Medibank Public was renamed Medicare by the Hawke Labor government, which also
changed the funding model, to an income tax surcharge, known as the Medicare Levy,
which was set at 1.5%, with exemptions for low income earners.[98] The Howard Coalition government
introduced an additional levy of 1.0%, known as the Medicare Levy
Surcharge, for those on high annual incomes ($70,000) and do not have
adequate levels of private hospital coverage.[99] This was part of an effort
by the Coalition to encourage take-up of private health insurance.
According to WHO, government funding covered 67.5% of Australia's health
care expenditures in 2004; private sources covered the remaining 32.5% of
expenditures.[50]
As with Australia, New Zealand's healthcare system is funded through
general taxation. According to the WHO, government sources covered 77.4% of
New Zealand's health care costs in 2004; private expenditures covered the
remaining 22.6%.[50]
Universal health care in most countries has been achieved by a mixed
model of funding. General taxation revenue is the primary source of
funding, but in many countries it is supplemented by specific levies (which
may be charged to the individual and/or an employer) or with the option of
private payments (either direct or via optional insurance) for services
beyond that covered by the public system.
Almost all European systems are financed through a mix of public and
private contributions.[108] The majority of universal
health care systems are funded primarily by tax revenue (e.g. Portugal[108]Spain, Denmark and Sweden).
Some nations, such as Germany, France[63] and Japan[109] employ a multi-payer
system in which health care is funded by private and public contributions.
However, much of the non-government funding is by defined contributions by
employers and employees to regulated non-profit sickness funds. These contributions
are compulsory and vary according to a person's salary, and are effectively
a form of hypothecated taxation.
A distinction is also made between municipal and national healthcare
funding. For example, one model is that the bulk of the healthcare is
funded by the municipality, speciality healthcare is provided and possibly
funded by a larger entity, such as a municipal co-operation board or the
state, and the medications are paid by a state agency.
Universal health care systems are modestly redistributive.
Progressivity of health care financing has limited implications for overall
income inequality.[110]
The term single-payer health care is used in the United States to
describe a funding mechanism meeting the costs of medical care from a
single fund. Although the fund holder is usually the government, some forms
of single-payer employ a public-private system.
Some countries (notably the United Kingdom, Italy, Spain and the
Nordic countries) choose to fund health care directly from taxation alone.
Other countries with insurance-based systems effectively meet the cost of
insuring those unable to insure themselves via social security arrangements funded
from taxation, either by directly paying their medical bills or by paying
for insurance premiums for those affected.
[edit] Compulsory
insurance
This is usually enforced via legislation requiring residents to
purchase insurance, though sometimes, in effect, the government provides
the insurance. Sometimes there may be a choice of multiple public and private
funds providing a standard service (e.g. as in Germany) or sometimes just a
single public fund (as in Canada). The U.S. Patient
Protection and Affordable Care Act is a law based on
compulsory insurance.[111]
In some European countries where there is private insurance and
universal health care, such as Germany, Belgium, and The Netherlands, the
problem of adverse selection (see Private insurance below) is overcome
using a risk compensation pool to equalize, as far as possible, the risks
between funds. Thus a fund with a predominantly healthy, younger population
has to pay into a compensation pool and a fund with an older and
predominantly less healthy population would receive funds from the pool. In
this way, sickness funds compete on price and there is no advantage to
eliminate people with higher risks because they are compensated for by
means of risk-adjusted capitation payments. Funds are not allowed to pick
and choose their policyholders or deny coverage, but then mainly compete on
price and service. In some countries the basic coverage level is set by the
government and cannot be modified.[112]
Ireland at one time had a "community rating" system
through VHI, effectively a single-payer or common
risk pool. The government later opened VHI to competition but without a
compensation pool. This resulted in foreign insurance companies entering
the Irish market and offering cheap health insurance to relatively healthy
segments of the market which then made higher profits at VHI's expense. The
government later re-introduced community rating through a pooling
arrangement and at least one main major insurance company, BUPA, then withdrew from the Irish market.
In some countries with universal coverage, private insurance often
excludes many health conditions which are expensive and which the state
health care system can provide. For example in the UK, one of the largest
private health care providers is BUPA which has a long list of general exclusions
even in its highest coverage policy.[113] In the USA dialysis
treatment for end stage renal failure is generally paid for by government
and not by the insurance industry. Persons with privatized Medicare
(Medicare Advantage) are the exception and must get their dialysis paid
through their insurance company, but persons with end stage renal failure
generally cannot buy Medicare Advantage plans.[114]
Among the potential solutions posited by economists are single payer
systems as well as other methods of ensuring that health insurance is
universal, such as by requiring all citizens to purchase insurance and
limiting the ability of insurance companies to deny insurance to
individuals or vary price between individuals.[115][116]
From Wikipedia, the free encyclopedia
The Conference called for urgent and effective national and
international action to develop and implement primary health care
throughout the world and particularly in developing countries in a spirit
of technical cooperation and in keeping with a New International Economic
Order. It urged governments, WHO and UNICEF, and other international
organizations, as well as multilateral and bilateral agencies,
non-governmental organizations, funding agencies, all health workers and
the whole world community to support national and international commitment
to primary health care and to channel increased technical and financial
support to it, particularly in developing countries. The Conference called
on all the aforementioned to collaborate in introducing, developing and
maintaining primary health care in accordance with the spirit and content
of the Declaration. The Declaration has 10 points and is non-binding on
member states.
[edit] Definition
of health
The first section of the declaration reaffirms the
WHO definition of health as "a
state of complete physical, mental and social well-being and not merely the
absence of disease or
infirmity."[2] The definition seeks to
include social and economic sectors within the scope of attaining health
and reaffirms health as a human right.
The declaration highlighted the inequity between the developed and
the developing countries and termed it politically, socially and
economically unacceptable.
[edit] Health as a socio-economic
issue and as a human right
The third section called for economic and social development as a
pre-requisite to the attainment of health for all. It also declared
positive effects on economic and social development and on world peace
through promotion and protection of health of the people.
Participation of people as a group or individually in planning and
implementing their health care was declared as a human right and duty.
This section emphasized on the role of the State in providing adequate health
and social measures. This section enunciated the call for Health
for all which became a campaign of the WHO in the coming years. It
defined Health for All as the attainment by all peoples of the world by the
year 2000 of a level of health that will permit them to lead a socially and
economically productive life. The declaration urged governments,
international organizations and the whole world community to take this up
as a main social target in the spirit of social justice.
[edit] Primary health care and
components
This section defined primary health care and
urged signatories to incorporate the concept of primary health care in
their health systems.
Primary health care has since been adopted by many member nations. More
recently, Margaret Chan,
the Director-General of the WHO has reaffirmed the primary health care
approach as the most efficient and cost-effective way to organize a health
system. She also pointed out that international evidence overwhelmingly
demonstrates that health systems oriented
towards primary health care produce better outcomes, at lower costs, and
with higher user satisfaction.[3]
The seventh section lists the components of primary health care. The
next two sections called on all governments to incorporate primary health
care approach in their health systems and urged international cooperation
in better use of the world's resources.
WE BASED OUR RESEARCH ORIENTATIONS ON ALL THESE.
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