Health care, or healthcare, is the improvement or maintenance of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals and allied health fields. Medicine, dentistry, pharmacy, midwifery, nursing, optometry, audiology, psychology, occupational therapy, physical therapy, athletic training, and other health professions all constitute health care. The term includes work done in providing primary care, secondary care, tertiary care, mental health care and public health.
Access to health care may vary across countries, communities, and individuals, influenced by social and economic conditions and health policies. Providing health care services means "the timely use of personal health services to achieve the best possible health outcomes". Factors to consider in terms of health care access include financial limitations (such as insurance coverage), geographical and logistical barriers (such as additional transportation costs and the ability to take paid time off work to use such services), sociocultural expectations, and personal limitations (lack of ability to communicate with health care providers, poor health literacy, low income). Limitations to health care services affect negatively the use of medical services, the efficacy of treatments, and overall outcome (well-being, mortality rates).
Health systems are the organizations established to meet the health needs of targeted populations. According to the World Health Organization (WHO), a well-functioning health care system requires a financing mechanism, a well-trained and adequately paid workforce, reliable information on which to base decisions and policies, and well-maintained health facilities to deliver quality medicines and technologies.
An efficient health care system can contribute to a significant part of a country's economy, development, and industrialization. Health care is an important determinant in promoting the general physical and mental health and well-being of people around the world. An example of this was the worldwide eradication of smallpox in 1980, declared by the WHO, as the first disease in human history to be eliminated by deliberate health care interventions.World Health Organization. Anniversary of smallpox eradication. Geneva, 18 June 2010.
Delivery
The delivery of modern health care depends on groups of trained professionals and paraprofessionals coming together as interdisciplinary teams.United States Department of Labor. Employment and Training Administration: Health care . Retrieved June 24, 2011. This includes professionals in medicine, psychology, physiotherapy, nursing, dentistry, midwifery and allied health, along with many others such as public health practitioners, community health workers and assistive personnel. These professionals systematically provide personal and population-based preventive, curative and rehabilitative care services.
While the definitions of the various types of health care vary based on the different cultural, political, organizational, and disciplinary perspectives, there is general consensus that primary care constitutes the first element of a continuous health care process and may also include the provision of secondary and tertiary levels of care.Thomas-MacLean R et al. No Cookie-Cutter Response: Conceptualizing Primary Health Care. Retrieved 26 August 2014. Health care is often classified as public or private, though this distinction has been contested as an oversimplification of how care is actually delivered.
Primary care
Primary care refers to the work of health professionals who act as a first point of consultation for all patients within the health care system. The primary care model supports first-contact, accessible, continuous, comprehensive and coordinated person-focused care. Such a professional would usually be a primary care physician, such as a general practitioner or family physician. Another professional would be a licensed independent practitioner such as a physiotherapist, or a non-physician primary care provider such as a physician assistant or nurse practitioner. Depending on the locality and health system organization, the patient may see another health care professional first, such as a pharmacist or nurse. Depending on the nature of the health condition, patients may be referred for secondary or tertiary care.
Primary care is often used as the term for the health care services that play a role in the local community. It can be provided in different settings, such as Urgent care centers that provide same-day appointments or services on a walk-in basis.
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 types 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 based on the reason for the patient's visit.World Health Organization. International Classification of Primary Care, Second edition (ICPC-2). Geneva. Accessed 24 June 2011.
Common chronic illnesses usually treated in primary care may include, for example, hypertension, diabetes, asthma, COPD, depression and anxiety, back pain, arthritis or thyroid dysfunction. Primary care also includes many basic maternal and child health care services, such as family planning services and vaccinations. In the United States, the 2013 National Health Interview Survey found that skin disorders (42.7%), osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory tract disease (22.1%, excluding asthma) were the most common reasons for accessing a physician.
In the United States, primary care physicians have begun to deliver primary care outside of the managed care (insurance-billing) system through direct primary care which is a subset of the more familiar concierge medicine. Physicians in this model bill patients directly for services, either on a pre-paid monthly, quarterly, or annual basis, or bill for each service in the office. Examples of direct primary care practices include Foundation Health in Colorado and Qliance in Washington.
In the context of global population aging, with increasing numbers of older adults at greater risk of chronic non-communicable diseases, rapidly increasing demand for primary care services is expected in both developed and developing countries.World Health Organization. Aging and life course: Our aging world. Geneva. Accessed 24 June 2011.Simmons J. Primary Care Needs New Innovations to Meet Growing Demands. HealthLeaders Media, May 27, 2009. The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary health care strategy.
Secondary care
Secondary care includes acute care: necessary treatment for a short period of time for a brief but serious illness, injury, or other health condition. This care is often found in a hospital emergency department. Secondary care also includes skilled attendance during childbirth, intensive care, and medical imaging services.
The term "secondary care" is sometimes used synonymously with "hospital care". However, many secondary care providers, such as psychiatrists, clinical psychologists, occupational therapists, most dental specialties or physiotherapists, do not necessarily work in hospitals. 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.
In countries that operate under a mixed market health care system, some physicians limit their practice to secondary care by requiring patients to see a primary care provider first. This restriction may be imposed under the terms of the payment agreements in private or group health insurance plans. In other cases, medical specialists may see patients without a referral, and patients may decide whether self-referral is preferred.
In other countries patient self-referral to a medical specialist for secondary care is rare as prior referral from another physician (either a primary care physician or another specialist) is considered necessary, regardless of whether the funding is from private insurance schemes or national health insurance.
Allied health professionals, such as physical therapists, respiratory therapists, occupational therapists, speech therapists, and dietitians, also generally work in secondary care, accessed through either patient self-referral or through physician referral.
Tertiary care
Tertiary care is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.Johns Hopkins Medicine. Patient Care: Tertiary Care Definition. Accessed 27 June 2011.
Examples of tertiary care services are cancer management, neurosurgery, cardiac surgery, plastic surgery, treatment for severe burns, advanced neonatology services, palliative, and other complex medical and surgical interventions.Emory University. School of Medicine. Accessed 27 June 2011.
Quaternary care The term quaternary care is sometimes used as an extension of tertiary care in reference to advanced levels of medicine which are highly specialized and not widely accessed. Experimental medicine and some types of uncommon diagnostic or surgical procedures are considered quaternary care. These services are usually only offered in a limited number of regional or national health care centers.Alberta Physician Link. Levels off Care. Retrieved 26 August 2014.
Home and community care
Many types of health care interventions are delivered outside of health facilities. They include many interventions of public health interest, such as food safety surveillance, distribution of condoms and needle-exchange programs for the prevention of transmissible diseases.
They also include the services of professionals in residential and community settings in support of self-care, home care, long-term care, assisted living, treatment for substance use disorders among other types of health and social care services.
Community rehabilitation services can assist with mobility and independence after the loss of limbs or loss of function. This can include prostheses, orthotics, or wheelchairs.
Many countries are dealing with aging populations, so one of the priorities of the health care system is to help seniors live full, independent lives in the comfort of their own homes. There is an entire section of health care geared to providing seniors with help in day-to-day activities at home such as transportation to and from doctor's appointments along with many other activities that are essential for their health and well-being. Although they provide home care for older adults in cooperation, family members and care workers may harbor diverging attitudes and values towards their joint efforts. This state of affairs presents a challenge for the design of ICT (information and communication technology) for home care.