Health care system
Encyclopedia
A health care 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 care systems around the world, with as many histories and organizational structures as there are nations. In some countries, health care system planning is distributed among market participants. In others, there is a concerted effort among government
s, 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.
, 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. Other dimensions for the evaluation of health care systems include quality, efficiency, acceptability, and equity
. They have also been described in the United States as "the five C's": Cost, Coverage, Consistency, Complexity, and Chronic Illness. Also, continuity of health care is a major goal.
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
, paramedic
s, dentist
s, medical laboratory technologists, therapists, psychologist
s, pharmacist
s, chiropractors
, optometrists
, community health worker
s, traditional medicine practitioners, and others.
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There are generally five primary methods of funding health care systems:
Most countries' systems feature a mix of all five models. One study based on data from the OECD concluded that all types of health care finance "are compatible with" an efficient health care 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.
Many forms of commercial health insurance control their costs by restricting the benefits that are paid by through deductible
s, 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 partnership
s, and market-based financial transaction tax
es. 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.
costs for health care practitioners are estimated to represent between 65% and 80% of renewable health system expenditures. There are three ways to pay medical practitioners. There has been growing interest in blending elements of these systems.
arrangements pay general practitioner
s (GPs) based on the service. They are even more
widely used for specialists working in ambulatory care
.
There are two ways to set fee levels:
, GPs are paid for each patient on their "list", usually with adjustments for factors such as age and gender. 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."
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."
In several OECD countries, general practitioners (GPs) are employed on salaries
for the government. 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." There has been movement away from this system.
, medicine
and health care
- deals with the resources, devices, and methods required to optimize the acquisition and use of information in health and biomedicine. Necessary tools for proper health information coding and management include clinical guidelines, formal medical terminologies
, and computers and other information and communication technologies. The kinds of data processed may include patients' medical records, hospital administration and clinical functions
, and human resources information
.
The use of health information lies at the root of evidence-based policy
and evidence-based management
in health care.
, health human resources
, and public health
.
Public health is concerned with threats to the overall health of a community based on population health
analysis. The population in question can be as small as a handful of people, or as large as all the inhabitants of several continents (for instance, in the case of a pandemic
). Public health is typically divided into epidemiology
, biostatistics
and health services. Environmental
, social, behavioral
, and occupational health are also important subfields.
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 vaccination
s 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. Another major public health concern is diabetes. 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.
Antibiotic resistance
is another major concern, leading to the reemergence of diseases such as tuberculosis
. The World Health Organization
, for its World Health Day 2011
campaign, is calling for intensified global commitment to safeguard antibiotics and other antimicrobial
medicines for future generations.
, in its annual survey, "Mirror, Mirror on the Wall", compares the performance of the health care 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. 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.
The World Health Organization
, in its World Health Report 2000
, provided a ranking of health care 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.
Life Expectancy vs Health Care Spending in 2007 for OECD Countries. The data source is http://www.oecd.org.
destroyed the health
system of Afghanistan
. Most medical professionals left the country in the 1980s and 1990s, and all medical training programmes ceased. In 2004 Afghanistan had one medical facility for every 27,000 people, and some centers were responsible for as many as 300,000 people. In 2004 international organizations provided a large share of medical care. An estimated one-quarter of the population had no access to health care. In 2003 there were 11 physicians and 18 nurses per 100,000 population, and the per capita health expenditure was US$28.
, according to information from a March 6, 2006 United States
report, does not compare well with the developed world. Algeria
has inadequate numbers of physicians (one per 1,000 people) and hospital beds (2.1 per 1,000 people) and poor access to water (87 percent of the population) and sanitation
(92 percent of the population). Given Algeria’s young population, policy favors preventive health care
and clinics over hospitals. In keeping with this policy, the government maintains an immunization
program. However, poor sanitation and unclean water still cause tuberculosis
, hepatitis
, measles
, typhoid fever
, cholera
, and dysentery
. In 2003 about 0.10 percent of the population aged 15–49 was living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV
/AIDS
). The poor generally receive health care [aid for by the government, but the wealthy pay for care according to a sliding scale. Access to health care is enhanced by the requirement that doctors and dentists work in public health
for at least five years. However, doctors are more easily found in the cities of the north than in the southern Sahara
region.
’s health care system is composed of three sectors: the public sector
, financed through tax
es; the private sector
, financed through voluntary insurance schemes
; and the social security
sector, financed through obligatory insurance schemes. The Ministry of Health and Social Action (MSAS), oversees all three subsectors of the health care system and is responsible for setting of regulation, evaluation and collecting statistics.
Argentina has three sectors. The public sector is funded and managed by Obras Sociales, umbrella organizations for Argentine worker's unions. There are over 300 Obras Sociales in Argentina, each chapter being organized according to the occupation of the beneficiary. These organizations vary greatly in quality and effectiveness. The top 30 chapters hold 73% of the beneficiaries and 75% of resources for all Obras Sociales schemes and the monthly average a beneficiary receives varies from $5–80 per month. MSAS has established a Solidarity Redistribution Fund (FSR) to try to address these beneficiary inequities. Only workers employed in the formal sector are covered under Obras Sociales insurance schemes and after Argentina’s economic crisis of 2001
, the number of those covered under these schemes fell slightly (as unemployment increased and employment in the informal sector rose). In 1999, there were 8.9 million beneficiaries covered by Obras Sociales. The private health care sector in Argentina is characterized by great heterogeneity and is made up of a great number of fragmented facilities and small networks; it consists of over 200 organizations and covers approximately 2 million Argentines. Private insurance often overlaps with other forms of health care coverage, thus it is difficult to estimate the degree to which beneficiaries are dependent on the public and private sectors. According to a 2000 report by the IRBC, foreign competition
has increased in Argentina’s private sector, with Swiss
, American and other Latin America
n health care provider
s entering the market
in recent years. This has been accompanied by little formal regulation. The public system serves those not covered by Obras Sociales or private insurance schemes. It also provides emergency services
. According to above-mentioned IRBC report, Argentina’s public system exhibits serious structural deterioration and managerial inefficiency; a high degree of administrative centralization at the provincial level
; rigidity in its staffing structure and labour relationships; no adequate system of incentives; inadequate information systems on which to base decision-making and control; serious deficits in facilities and equipment maintenance; and a system of management ill-suited to its size. The public system is highly decentralized to the provincial level; often primary care
is even under the purview of local townships. Since 2001, the number of Argentines relying on public services has seen an increase. According to 2000 figures, 37.4% of Argentines had no health insurance, 48.8 were covered under Obras Sociales, 8.6% had private insurance, and 3.8% were covered by both Obras Sociales and private insurance schemes.
the current system, known as Medicare
, was instituted in 1984. It coexists with a private health system. All legal permanent residents are entitled to government-paid public hospital care. Treatment by private doctors is also paid by the government when the doctor direct bills the Health Department (Bulk Billing). Medicare is funded partly by a 1.5% income tax levy (with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. There is an uncapped 30% subsidy on private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme
under which listing and a government subsidy is dependent on expert evaluation of the comparative cost-effectiveness of new pharmaceuticals. In 2005, Australia spent 8.8% of GDP
on health care, or US$3,181 per capita. Of that, approximately 67% was government expenditure.
General practitioners can be found in private practices or attached to clinics and hospitals. A person is free to consult or register with any of their own choosing. Similarly with specialist consultants. Consultations usually end with a handing over of money and very few doctors offer payment by card of any type. Reimbursements are available for those with insurance, either private or public. If a patient is on a private scheme, or is uninsured, the fee is payable in full at the time of the appointment.
The majority of dentists in Belgium are private, though there are those who accept part-payment on state insurance.
As with general practitioners, people in Belgium can arrange to see a specialist of choice at any hospital. Those going into hospital for a planned stay need to take personal care items such as a towel and soap with them as these are not generally provided.
In Brussels the eleven big public hospitals are organized under the Iris association. http://www.iris-hopitaux.be/)
The Ministry of Health recognizes homeopathy, acupuncture, osteopathy and chiropractic as reimbursable alternative treatments. Reimbursement is possible only if the practitioner is registered as a qualified doctor.
If a call is made to the Emergency services using the old emergency 100 or the common European 112 telephone number, an ambulance will take transport the patient to the nearest emergency centre or the best centre suited according to need, for example, a specialist burns unit.
Pharmacies are ubiquitous in Belgium, with the green cross sign everywhere. There is a rota system for chemists to open outside of usual hours and through the night.
Health care insurance is a part of the Belgian social security system. To benefit a person must join a health insurance fund mutuelle (mutualité) or ziekenfonds (mutualiteit) for which an employer's certificate is required if the employer is to contribute to the cost. If employed a person's contributions is automatically deducted from salary. The employer will also pay a contribution. Health insurance funds will reimburse medical costs. The choice of mutual insurer is up to the individual. Most of them are affiliated to a religious or political institution but there is no real difference between them because reimbursement rates are fixed by the Belgian government.
Insurance funds do not cover 100 per cent of your bills and typical reimbursement is between half to three-quarters of a typical doctors or specialists visit.
Insured persons have a standardized credit card style SIS-card which is needed in pharmacies and hospitals.
's health care system development accelerated in the early 1960s with the establishment of the Department of Public Health and the opening of new hospitals and dispensaries throughout the country. By the early 1990s, health care was provided through twenty-nine general hospitals (including five leprosy hospitals, three army hospitals, and one mobile hospital), forty-six dispensaries, sixty-seven basic health units, four indigenous-medicine dispensaries, and fifteen malaria
eradication centers. The major hospitals were the National Referral Hospital
in Thimphu
, and other hospitals in Geylegphug, and Tashigang. Hospital beds in 1988 totaled 932. There was a severe shortage of health-care personnel with official statistics reporting only 142 physician
s and 678 paramedic
s, about one health-care professional for every 2,000 people, or only one physician for almost 10,000 people. Training for health-care assistants, nurses' aide
s, midwives, and primary health-care workers was provided at the Royal Institute of Health Sciences
, associated with Thimphu General Hospital, which was established in 1974. Graduates of the school were the core of the national public health system and helped staff the primary care basic health units throughout the country. Additional health-care workers were recruited from among volunteers in villages to supplement primary health care. The Institute of Traditional Medicine Services
supports indigenous medical centers associated with the district hospitals.
) , which serves the majority of the population, and a private sector, managed by health insurance funds and private entrepreneurs.
The public health system, SUS, was established in 1988 by the Brazilian Constitution, and sits on 3 basic principles of universality, comprehensiveness and equity. Universality states that all citizens must have access to health care services, without any form of discrimination, regarding skin color, income, social status, gender or any other variable.
Government standards state that citizen's health is the result of multiple variables, including employment, income, access to land, sanitation services, access and quality of health services, education, psychic, social and family conditions, and are entitled to full and complete health care, comprising prevention, treatment and rehabilitation. Equity states that health policies should be oriented towards the reduction of inequalities between population groups and individuals, being the most needed the ones for whom policies should be first directed.
SUS also has guidelines for its implementation, the most peculiar being popular participation, which defines that all policies are to be planned and supervised directly by the population, through local, city, state and national health councils and conferences. This is regarded as a very advanced form of direct democracy and has established the guidelines for many similar initiatives in sectors other than health all over Brazilian society.
The level of public spending is particularly high in relation to GDP for a country of Brazil’s income level and in comparison with its emerging-market peers. Government outlays on health care alone account for nearly 9% of GDP, the second largest item of spending following social protection. In health care, a number of conventional output indicators are not out of step with OECD averages. Following the decentralisation of service delivery in the early 1990s, increasing emphasis has appropriately been placed on enhancing preventive care. But, in a decentralised setting, cost-effectiveness depends a great deal on the ability of service deliverers to exploit economies of scale and scope. Experience with inter-municipal initiatives for procurement, as well as flexible arrangements for hospital administration and human-resource management, is by and large positive.
Private Health Insurance is widely available in Brazil and may be purchased on an individual-basis or obtained as a work benefit (major employers usually offer private health insurance benefits). Public health care is still accessible for those who choose to obtain private health insurance. As of March, 2007, more than 37 million Brazilians had some sort of private health insurance.
began overall reform of its antiquated health system, inherited from the communist era, only in 1999. In the 1990s, private medical practices expanded somewhat, but most Bulgarians relied on communist-era public clinic
s while paying high prices for special care. During that period, national health indicators generally worsened as economic crises substantially decreased health funding. The subsequent health reform program has introduced mandatory employee health insurance through the National Health Insurance Fund (NHIF), which since 2000 has paid a gradually increasing portion of primary health-care costs. Employees and employers pay an increasing, mandatory percentage of salaries
, with the goal of gradually reducing state support of health care. Private health insurance plays only a supplementary role. The system also has been decentralized by making municipalities responsible for their own health-care facilities, and by 2005 most primary care came from private physician
s. Pharmaceutical distribution also was decentralized.
In the early 2000s, the hospital system was reduced substantially to limit reliance on hospitals for routine care. Anticipated membership in the European Union
(2007) was a major motivation for this trend. Between 2002 and 2003, the number of hospital beds was reduced by 56 percent to 24,300. However, the pace of reduction slowed in the early 2000s; in 2004 some 258 hospitals were in operation, compared with the estimated optimal number of 140. Between 2002 and 2004, health-care expenditures in the national budget increased from 3.8 percent to 4.3 percent, with the NHIF accounting for more than 60 percent of annual expenditures.
In the 1990s, the quality of medical research and training decreased seriously because of low funding. In the early 2000s, the emphasis of medical and paramedic
al training, which was conducted in five medical schools, was preparation of primary-care personnel to overcome shortages resulting from the communist system’s long-term emphasis on training specialists. Experts considered that Bulgaria had an adequate supply of doctor
s but a shortage of other medical personnel. In 2000 Bulgaria had 3.4 doctors, 3.9 nurses, and 0.5 midwives per 1,000 population.
has a federally sponsored, publicly funded Medicare
system, with most services provided by the private sector. The country's prime minister and most premiers say they are committed to the Social Union Framework Agreement
that promotes "comprehensiveness, universality, portability, public administration and accessibility" in health care. 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. Each province may opt out, though none currently choose to. Some provinces still charge premiums to individuals and families. Many employers also offer additional health coverage as a benefit.
Canada's system is known as a single payer system, where basic services are provided by private doctors, (since 2002 they have been allowed to incorporate), with the entire fee paid for by the government at the same rate. Most family doctors receive a fee per visit. These rates are negotiated between the provincial governments and the province's medical associations, usually on an annual basis. A physician cannot charge a fee for a service that is higher than the negotiated rate — even to patients who are not covered by the publicly funded system — unless he or she opts out of billing the publicly funded system altogether. Pharmaceutical costs are set at a global median by government price controls. Other areas of health care, such as dentistry
and optometry
, are wholly private, although in some provinces emergency visits to optometrists are partly covered by medicare. In 2005, Canada spent 9.8% of GDP on health care, or US$3,463 per capita. Of that, approximately 70% was government expenditure.
In May 2011, the Health Council released a report entitled: "Progress Report 2011: Health Care Renewal in Canada", which provides a pan-Canadian look at five key commitments of the 2003 First Ministers' Accord on Health Care Renewal and the 2004 10-Year Plan to Strengthen Health Care. This report highlights the progress being achieved to date on wait times, pharmaceuticals management, electronic health records, teletriage, and health innovation.
are limited, and some medicines are in short supply or unavailable. There are hospitals in Praia
and Mindelo
, with smaller medical facilities in other places. The islands of Brava
and Santo Antão no longer have functioning airports so air evacuation in the event of a medical emergency is nearly impossible from these two islands. Brava also has limited inter-island ferry service.
has maintained a dual health care system in which its citizens can voluntarily opt for coverage by either the public National Health Insurance Fund or any of the country's private health insurance companies. 68% of the population is covered by the public fund and 18% by private companies. The remaining 14% is covered by other not-for-profit agencies or has no specific coverage. The system's duality has led to increasing inequalities prompting the Chilean government to introduce major reforms in health care provision. Chile's health care system is funded by a universal income tax deduction equal to 7% of every worker's wage. Many private health insurance companies encourage people to pay a variable extra on top of the 7% premium to upgrade their basic health plans. Because of this arrangement, the public and private health subsystems have existed almost completely separate from each other rather than coordinating to achieve common health objectives.
provides universal health care to its citizens and permanent residents.
consists of a government-coordinated system that guarantees universal coverage and consumes a lower proportion of the nation's GDP (7.3%) than some highly privatised systems (e.g. USA: 16%) (OECD 2008). The system does charge fees in treating elective treatment for patients from abroad, but tourists who fall ill are treated free in Cuban hospitals. Cuba attracts patients mostly from Latin America
and Europe
by offering care of comparable quality to a developed nation but at much lower prices. Cuba's own health indicators are the best in Latin America and surpass those of the US in some respects (infant mortality rates, underweight babies, HIV infection, immunisation rates, doctor per population rates). (UNDP 2006: Tables 6,7,9,10) In 2005, Cuba spent 7.6% of GDP on health care, or US$310 per capita. Of that, approximately 91% was government expenditure.
The total fertility rate in 2000 was 1.7, while the maternal mortality rate was 10 per 100,000 live births as of 1998. Studies show that between 1980 and 1993, 63% of married women (ages 15 to 49) used contraception. As of 2002 cardiovascular diseases and cancer were the leading causes of death. Denmark's cancer rates were the highest in the European Union. In 1999, there were only 12 reported cases of tuberculosis per 100,000 people. As of 1999, the number of people living with HIV/AIDS was estimated at 4,300 and deaths from AIDS that year were estimated at less than 100. HIV prevalence was 0.17 per 100 adults.
Danish citizens may choose between two systems of primary health care: medical care paid for by the government provided by a doctor whom the individual chooses for a year and by those specialists to whom the doctor refers the patient; or complete freedom of choice of any physician or specialist at any time, with state reimbursement of about two-thirds of the cost for medical bills paid directly by the patient. Most Danes opt for the former. All patients receive subsidies on pharmaceuticals and vital drugs; everyone must pay a share of dental bills. As of 1999, total health care expenditure was estimated at 8.4% of GDP.
Responsibility for the public hospital service rests with county authorities. Counties form public hospital regions, each of which is allotted one or two larger hospitals with specialists and two to four smaller hospitals where medical treatment is practically totally paid for by the government. State-appointed medical health officers, responsible to the National Board of Health, are employed to advise local governments on health matters. Public health authorities have waged large-scale campaigns against tuberculosis, venereal diseases, diphtheria, and poliomyelitis. The government-paid guidance and assistance given to mothers of newborn children by public health nurses have resulted in a low infant mortality rate of 4 per 1,000 live births (2000). Medical treatment is government-paid up to school age, when government-paid school medical inspections begin. As of 1999, children up to one year of age were vaccinated against diphtheria, pertussis, and tetanus (99%) and measles (92%). In 2000, life expectancy at birth was 76 years for males and females. The overall death rate was 11 per 1,000 people in 1999.
Read more: Health - Denmark - system http://www.nationsencyclopedia.com/Europe/Denmark-HEALTH.html#ixzz0kk32t7BP
is generally poor as it remains one of the poorest countries in the world. About one-third of the population lives in extreme poverty
, and more than half survives on less than US$1 per day. Health care and welfare resources generally are believed to be poor, although reliable information about conditions is often difficult to obtain. In 2001, the most recent year for which figures are available, the Eritrean government spent 5.7 percent of gross domestic product
on national health accounts. The World Health Organization
(WHO) estimated that in 2004 there were only three physicians per 100,000 people in Eritrea
. The two-year war with Ethiopia
, coming on the heels of a 30-year struggle for independence, negatively affected the health sector and the general welfare. The rate of prevalence of human immunodeficiency virus/acquired immune deficiency syndrome (HIV
/AIDS
), although low by sub-Saharan Africa
n standards, was high enough at 2.7 percent in 2003 to be considered a generalized epidemic. In the decade since 1995, however, impressive results have been achieved in lowering maternal and child mortality
rates and in immunizing children against childhood diseases. In 2003 average life expectancy
was slightly less than 53 years, according to the WHO.
, and infant mortality rates. These expenditures stagnated or declined during the 1998–2000 war with Eritrea
, but in the years since, outlays for health have grown steadily. In 2000–2001, the budget allocation for the health sector was approximately US$144 million; health expenditures per capita were estimated at US$4.50, compared with US$10 on average in sub-Saharan Africa. In 2000 the country counted one hospital bed per 4,900 population and more than 27,000 people per primary health care facility. The physician
to population ratio was 1:48,000, the nurse to population ratio, 1:12,000. Overall, there were 20 trained health providers per 100,000 inhabitants. These ratios have since shown some improvement. Health care is disproportionately available in urban centers; in rural areas where the vast majority of the population resides, access to health care varies from limited to nonexistent. As of the end of 2003, the United Nations
(UN) reported that 4.4 percent of adults were infected with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS); other estimates of the rate of infection ranged from a low of 7 percent to a high of 18 percent. Whatever the actual rate, the prevalence of HIV/AIDS
has contributed to falling life expectancy since the early 1990s. According to the Ministry of Health, one-third of current young adult deaths are AIDS-related. Malnutrition
is widespread, especially among children, as is food insecurity. Because of growing population pressure on agricultural and pastoral land, soil degradation, and severe droughts that have occurred each decade since the 1970s, per capita food production is declining. According to the UN and the World Bank
, Ethiopia at present suffers from a structural food deficit such that even in the most productive years, at least 5 million Ethiopians require food relief.
In 2002 the government embarked on a poverty reduction program that called for outlays in education, health, sanitation, and water. A polio vaccination
campaign for 14 million children has been carried out, and a program to resettle
some 2 million subsistence farmers is underway. In November 2004, the government launched a five-year program to expand primary health care. In January 2005, it began distributing antiretroviral drugs, hoping to reach up to 30,000 HIV-infected adults.
, public medical services at clinics and hospitals are run by the municipalities (local government) and are funded 78% by taxation, 20% by patients through access charges, and by others 2%. Patient access charges are subject to annual caps. For example GP visits are (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, all treatment and medications thereafter are paid for by the government. Taxation funding is partly local and partly nationally based. Patients can claim re-imbursement of part of their prescription costs from KELA. Finland also has a much smaller private medical sector which 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. Private sector patients can claim a contribution from KELA towards their private medical costs (including dentistry
) if they choose to be treated in the more expensive private sector, or they can join private insurance funds. However, private sector health care is mainly in the primary care sector. There are virtually no private hospitals, the main hospitals being either municipally owned (funded from local taxes) or run by the teaching universities (funded jointly by the municipalities and the national government). In 2005, Finland spent 7.5% of GDP on health care, or US$2,824 per capita. Of that, approximately 78% was government expenditure.
, the World Health Organization
found that France provided the "best overall health care" in the world. In 2005, France spent 11.2% of GDP on health care, or US$3,926 per capita. Of that, approximately 80% was government expenditure.
In France
, most doctors remain in private practice; there are both private
and public
hospital
s. Social Security consists of several public organizations, distinct from the state government, with separate budgets that refunds patients for care in both private and public facilities. It generally refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Supplemental coverage may be bought from private insurers, most of them nonprofit, mutual insurers, to the point that the word "mutuelle" (mutual) has come to be a synonym of supplemental private insurer in common language. Until recently, social security coverage was restricted to those who contributed to social security (generally, workers, unemployed or retirees), excluding some few poor segments of the population; the government of Lionel Jospin
put into place the "universal health coverage" allowing the entire French population to benefit from Health care. In some systems, patients can also take private health insurance, but choose to receive care at public hospitals, if allowed by the private insurer. For serious illness, regardless of the insurance regime, the national health system will assume the cost of long-term remedial treatment.
has a universal multi-payer system with two main types of health insurance: "Law-enforced health insurance" (Gesetzliche Krankenversicherung) known as sickness funds and "Private" (Private Krankenversicherung). Compulsory insurance applies to those below a set income level and is provided through private non-profit "sickness funds" at common rates for all members, and is paid for with joint employer-employee contributions. Provider compensation rates are negotiated in complex corporatist
social bargaining among specified autonomously organized interest groups (e.g. physicians' associations) at the level of federal states
(Länder). The sickness funds are mandated to provide a wide range of coverages and cannot refuse membership or otherwise discriminate on an actuarial basis. Small numbers of persons are covered by tax-funded government employee insurance or social welfare insurance. Persons with incomes above the prescribed compulsory insurance level may opt into the sickness fund system, which a majority do, or purchase private insurance. Private supplementary insurance to the sickness funds of various sorts is available. In 2005, Germany spent 10.7% of GDP on health care, or US$3,628 per capita. Of that, approximately 77% was government expenditure.
, most health care is provided by the government, but hospitals and clinics run by religious groups also play an important role. Some for-profit clinics exist, but they provide less than 2% of health services. Health care is very variable through the country. The major urban centres are well served, but rural areas often have no modern health care. Patients in these areas either rely on traditional medicine or travel great distances for care. In 2005, Ghana spent 6.2% of GDP on health care, or US$30 per capita. Of that, approximately 34% was government expenditure.
is universal and is ranked as one of the best in the world. In a 2000 World Health Organization
report it was ranked 14th in the overall assessment and 11th at quality of service, surpassing countries such as the United Kingdom
] (18th) and Germany
(25th). In 2010 there were 131 hospitals with 35,000 beds in the country, but on 1 July 2011 the Ministry for Health and Social Solidarity announced its proposal to shorten the number to 83 hospitals with 33,000 beds. Greece's healthcare expenditures as a percentage of GDP were 9.6% in 2007 according to a 2011 OECD report, just above the OECD average of 9.5%. The country has the largest number of doctors-to-population ratio of any OECD country.
Life expectancy
in Greece is 80.3 years, above the OECD average of 79.5. and among the highest in the world. The same OECD report showed that Greece had the largest percentage of adult daily smokers of any of the 34 OECD members. The country's obesity rate is 18.1%, which is above the OECD average of 15.1% but considerably below the American rate of 27.7%. In 2008 Greece had the highest rate of perceived good health in the OECD, at 98.5%. Infant mortality is one of the lowest in the developed world
with a rate of 3.1 deaths/1000 live births.
Guinea
has been reorganizing its health system since the Bamako Initiative
of 1987 formally promoted community-based methods of increasing accessibility of primary health care
to the population, including community ownership and local budgeting, resulting in more efficient and equitable provision of drugs and other essential health care resources.
In June 2011, the Guinean government announced the establishment of an air ticket solidarity levy on all flights taking off from national soil, with funds going to UNITAID
to support expanded access to treatment for HIV
/AIDS
, tuberculosis
and malaria
. Guinea is among the growing number of countries and development partners using market-based transactions taxes and other innovative financing
mechanisms to expand financing options for health care in resource-limited settings.
, the hospitals are run by government, charitable trusts and by private organizations. The government hospitals in rural areas are called the (PHC
)s primary health centre. Major hospitals are located in district head quarters or major cities. Apart from the modern system of medicine, traditional and indigenous medicinal systems like Ayurvedic and Unani
systems are in practice throughout the country. The Modern System of Medicine is regulated by the Medical Council of India
, whereas the Alternative systems recognised by Government of India are regulated by the Department of AYUSH
(an acronym for Ayurveda
, Yoga
, Unani
, Siddha
& Homeopathy
) under the Ministry of Health, Government of India. PHCs are non-existent in most places, due to poor pay and scarcity of resources. Patients generally prefer private health clinics. These days some of the major corporate hospitals are attracting patients from neighboring countries such as Pakistan
, countries in the Middle East
and some Europe
an countries by providing quality treatment at low cost. In 2005, India spent 5% of GDP on health care, or US$36 per capita. Of that, approximately 19% was government expenditure.,.In Addition Acupressure,Acupuncture,Yoga,Naturopathy,Physiotherapy and Electrohomeopathy are the other systems of treatment used in India
had a three-tiered system of community health
centers in the late 1990s, with 0.66 hospital beds per 1,000 population, the lowest rate among members of the Association of Southeast Asian Nations
(ASEAN). In the mid-1990s, according to the World Health Organization
(WHO), there were 16 physician
s per 100,000 population in Indonesia, 50 nurses per 100,000, and 26 midwives per 100,000. Both traditional and modern health practices are employed. Government health expenditures are about 3.7 percent of the gross domestic product
(GDP). There is about a 75:25 percent ratio of public to private health-care expenditures.
are entitled to health care through the public health care system, which is managed by the Health Service Executive
and funded by general taxation. A person may be required to pay a subsidised fee for certain health care received; this depends on income, age, illness or disability. All maternity services are however paid for by the government, as well as health care of infants under 6 months of age. Emergency care is provided at a cost of €120 for a visit to hospitals Accident and Emergency departments.
, the publicly funded medical system is universal and compulsory. In 2005, Israel spent 7.8% of GDP on health care, or US$1,533 per capita. Of that, approximately 66% was government expenditure.
, Italy had the world's "second overall best" healthcare system in the world, coming after France
, and surpassing Spain
, Oman
and Japan
.
In 1978 Italy
adopted a tax-funded universal health care
system called "National Health Service" (in Italian
: Servizio Sanitario Nazionale), which was closely modeled on the British system. The SSN covers general practice (distinct between adult and pediatric practice), outpatient and inpatient treatments, and the cost of most (but not all) drugs and sanitary ware.
The government sets LEA (fundamental levels of care, Livelli essenziali di assistenza in Italian) which cover all necessary treatments, which the state must guarantee to all, paid for by the government, or for a "ticket", a share of the costs (but various categories are exempted).
The public system has also the duty of prevention at place of work and in the general environment.
A private sector also exists, with a minority role in medicine but a principal role in dental health, as most people prefer private dental services.
In Italy the public system has the unique feature of paying general practitioners a fee per capita
per year, a salary system, that does not reward repeat visits, testing, and referrals.
While there is a paucity of nurses, Italy has one of the highest doctor per capita ratios at 3.9 doctor
s per 1,000 patients.
In 2005, Italy spent 8.9% of GDP on health care, or US$2,714 per capita. Of that, approximately 76% was government expenditure.
, services are provided either through regional/national public hospitals or through private hospitals/clinics, and patients have universal access to any facility, though hospitals tend to charge higher for those without a referral. Public health insurance covers most citizens/residents and pays 70% or more cost for each care and each prescribed drug. Patients are responsible for the remainder (upper limits apply). The monthly insurance premium is 0-50,000 JPY per household (scaled to annual income). Supplementary private health insurance is available only to cover the co-payments or non-covered costs, and usually makes a fixed payment per days in hospital or per surgery performed, rather than per actual expenditure. In 2005, Japan spent 8.2% of GDP on health care, or US$2,908 per capita. Of that, approximately 83% was government expenditure.
has quite an advanced health care
system, although services remain highly concentrated in Amman
. Government figures have put total health spending in 2002 at some 7.5 percent of Gross domestic product
(GDP), while international health organizations place the figure even higher, at approximately 9.3 percent of GDP. The country’s health care system is divided between public and private institutions. In the public sector, the Ministry of Health operates 1,245 primary health-care centers and 27 hospitals, accounting for 37 percent of all hospital beds in the country; the military’s Royal Medical Services runs 11 hospital
s, providing 24 percent of all beds; and the Jordan University Hospital accounts for 3 percent of total beds in the country. The private sector provides 36 percent of all hospital beds, distributed among 56 hospitals. In 1 June 2007, Jordan Hospital (as the biggest private hospital) was the first general specialty hospital who gets the international accreditation (JCI).Treatment cost in Jordan hospitals is less than in other countries.
per 10,000 inhabitants fell by 15 percent, to 34.6, and the ratio of hospital beds per 10,000 inhabitants fell by 46 percent, to 74. By 2005 those indicators had recovered somewhat, to 55 and 77, respectively. Since 1991, health care has consistently lacked adequate government funding; in 2005 only 2.5 percent of gross domestic product
went for that purpose. A government health reform program aims to increase that figure to 4 percent in 2010. A compulsory health insurance
system has been in the planning stages for several years. Wages for health workers are extremely low, and equipment is in critically short supply. The main foreign source of medical equipment is Japan. Because of cost, the emphasis of treatment increasingly is on outpatient care instead of the hospital care preferred under the Soviet system. The health system is in crisis in rural areas such as the Aral Sea
region, where health is most affected by pollution
.
, one of the world’s poorest nations, is greatly affected by poverty
, malnutrition
, and inadequate hygiene
and sanitation
. Mali's health and development indicators rank among the worst in the world. In 2000 only 62–65 percent of the population was estimated to have access to safe drinking water and only 69 percent to sanitation services of some kind; only 8 percent was estimated to have access to modern sanitation facilities. Only 20 percent of the nation’s villages and livestock watering holes had modern water facilities.
Mali is dependent on international development organizations and foreign missionary groups for much of its health care. In 2001 general government expenditures on health constituted 6.8 percent of total general government expenditures and 4.3 percent of gross domestic product
(GDP), totaling only about US$4 per capita at an average exchange rate. Medical facilities in Mali are very limited, especially outside of Bamako
, and medicines are in short supply. There were only 5 physicians per 100,000 inhabitants in the 1990s and 24 hospital beds per 100,000 in 1998. In 1999 only 36 percent of Malians were estimated to have access to health services within a five-kilometer radius.
Malaysian society places importance on the expansion and development of health care, putting 5% of the government social sector development budget into public health care
— an increase of more than 47% over the previous figure. This has meant an overall increase of more than RM 2 billion. With a rising and ageing population, the Government wishes to improve in many areas including the refurbishment of existing hospitals, building and equipping new hospitals, expansion of the number of polyclinics, and improvements in training and expansion of telehealth
. Over the last couple of years they have increased their efforts to overhaul the systems and attract more foreign investment.
There is still a shortage in the medical workforce, especially of highly trained specialists. As a result certain medical care and treatment is available only in large cities. Recent efforts to bring many facilities to other towns have been hampered by lack of expertise to run the available equipment made ready by investments.
The majority of private hospital
facilities are in urban areas and, unlike many of the public hospitals, are equipped with the latest diagnostic and imaging facilities.
Health care in Mexico is provided via public
institutions or private entities. Health care delivered through private health care organizations operates entirely on the free-market system (e.g. it is available to those who can afford it). Public health care delivery, on the other hand, is accomplished via an elaborate provisioning and delivery system put in place by the Mexican Federal Government and the Mexican Social Security Institute
(IMSS).
Advances in medicine and increasing health knowledge have increased the life expectancy in Mexico
by an average of 25 years in the last years of the XX century. Of the 6.6% GDP of government revenue spent on health, this provides only health insurance to 40% of the population who are privately employed. The health care system has three components: the social security institute, governmental services for the un-insured (Seguro Popular), and the private sector that is financed almost completely from out of pocket money. The IMSS
, the largest social institution in Latin America, is the governmental institution responsible of executing the Federal Government's health policy. The number of public hospitals in Mexico has increased 41% in ten years from 1985 to 1995.
According to the site www.internationalliving.com, health care in Mexico is described as very good to excellent while being highly affordable, with every medium to large city in Mexico having at least one first-rate hospital. In fact, some California insurers sell health insurance
policies that require members to go to Mexico for health care where costs are 40% lower. Some of Mexico's top-rate hospitals are internationally accredited. Americans, particularly those living near the Mexican border, now routinely cross the border into Mexico for medical care. Popular specialties include dentistry
and plastic surgery
. Mexican dentists often charge 20 to 25 percent of US prices, while other procedures typically cost a third what they would cost in the US.
has inadequate numbers of physicians (0.5 per 1,000 people) and hospital beds (1.0 per 1,000 people) and poor access to water
(82 percent of the population) and sanitation
(75 percent of the population). The health care system includes 122 hospitals, 2,400 health centers, and 4 university clinics, but they are poorly maintained and lack adequate capacity to meet the demand for medical care. Only 24,000 beds are available for 6 million patients seeking care each year, including 3 million emergency cases. The health budget corresponds to 1.1 percent of gross domestic product
and 5.5 percent of the central government budget.
, has since January 2006 been provided by a system of compulsory insurance backed by a risk equalization
program so that the insured are not penalized for their age or health status. This is meant to encourage competition between health care providers and insurers. Children under 18 are insured by the government, and special assistance is available to those with limited incomes. In 2005, the Netherlands spent 9.2% of GDP on health care, or US$3,560 per capita. Of that, approximately 65% was government expenditure.
hospitals are public and treat citizens or permanent residents, with the fees paid by the government, and are managed by District Health Boards. Under the Labour
coalition governments (1999–2008), there were plans to make primary health care
available with charges paid for by the government. At present government subsidies exist in health care. The cost of visiting a GP ranges from government-paid to $45.00 for children and from government-paid to $75.00 for adults under the current subsidies. This system is funded by taxes. The New Zealand government agency PHARMAC subsidizes certain pharmaceuticals depending upon their category. Co-payments exist, however these are lower if the user has a Community Services Card or High User Health Card. In 2005, New Zealand spent 8.9% of GDP on health care, or US$2,403 per capita. Of that, approximately 77% was government expenditure.
suffers from a chronic lack of resources and a small number of health providers relative to population. Some medicines are in short supply or unavailable. There are government hospitals in Niamey
(with three main hospitals in Niamey, including the Hôpital National de Niamey and the Hôpital National De Lamordé), Maradi, Tahoua
, Zinder
and other large cities, with smaller medical clinics in most towns. Medical facilities are limited in both supplies and staff, with a small government health care system supplemented by private, charitable, religious, and Non-government organisation operated clinics and public health programs (such as Galmi Hospital
near Birnin Konni and Maradi). Government hospitals, as well as public health
programmes, fall under the control of the Nigerien Ministry of Health. A number of private for profit clinics ("Cabinets Médical Privé") operate in Niamey. The total expenditure on health per capita in 2005 was Intl $25. There were 377 Physicians in Niger in 2004, a ratio of 0.03 per 10,000 population. In 2003, 89.2 percent of individual expenditures on health care were "out-of-pocket" (paid by the patient).
is a concurrent responsibility of the three tiers of government in the country. However, because Nigeria operates a mixed economy
, private providers of health care have a visible role to play in health care delivery. The federal government
's role is mostly limited to coordinating the affairs of the university
teaching hospital
s, while the state government manages the various general hospital
s and the local government
focus on dispensaries. The total expenditure on health care as % of GDP is 4.6, while the percentage of federal government expenditure on health care is about 1.5%. A long run indicator of the ability of the country to provide food sustenance and avoid malnutrition
is the rate of growth of per capita food production; from 1970–1990, the rate for Nigeria was 0.25%. Though small, the positive rate of per capita may be due to Nigeria's importation of food products. Historically, health insurance in Nigeria can be applied to a few instances: government-paid health care provided and financed for all citizens, health care provided by government through a special health insurance scheme for government employees and private firms entering contracts with private health care providers. However, there are few people who fall within the three instances. In May 1999, the government created the National Health Insurance
Scheme, the scheme encompasses government employees, the organized private sector
and the informal sector. Legislative wise, the scheme also covers children under five, permanently disabled persons and prison inmates. In 2004, the administration of Obasanjo further gave more legislative powers to the scheme with positive amendments to the original 1999 legislative act.
has a national medical service and health insurance system. As of 2000, some 99 percent of the population had access to sanitation
, and 100 percent had access to water, but water was not always potable. Medical treatment is paid for by the state. In the past, there reportedly has been one doctor for every 700 inhabitants and one hospital bed for every 350 inhabitants. Health expenditures in 2001 were 2.5 percent of gross domestic product, and 73 percent of health expenditures were made in the public sector. There were no reported human immuno-deficiency virus/acquired immune deficiency syndrome (HIV/AIDS) cases as of 2007. However, it is estimated that between 500,000 and 3 million people died from famine
in the 1990s, and a 1998 United Nations
(UN) World Food Program report revealed that 60 percent of children suffered from malnutrition
, and 16 percent were acutely malnourished. UN statistics for the period 1999–2001 reveal that North Korea’s daily per capita food supply was one of the lowest in Asia, exceeding only that of Cambodia
, Laos
, and Tajikistan
, and one of the lowest worldwide. Because of continuing economic problems, food shortages and chronic malnutrition prevail in the 2000s.
physical and mental health for all and dental health for children under the age of 16. Hospitals are paid by the state and doctor visit fees are capped at a fairly low rate. Medicine is market price, but people needing the medicine more than three months a year, gets prescription with high discount. There is also a yearly cap for people with high medical expenses.
Private health care exists: Most adults use private dental care, the public only treat people, for a normal fee, when they have free capacity. Health-related plastic surgery (like burn damage) is covered by the public system, while cosmetic surgery in general is private. There are a number of private psychologists, there are also some private general practice doctors and specialists.
Public health care is financed by a special-purpose income tax on the order of 8-11%, loosely translated as "public benefits fee" (Norwegian: trygdeavgift og Folketrygden). This can be considered a mandatory public insurance, covering not only health care but also loss of income during sick leave, public pension, unemployment benefits, benefits for single parents and a few others. The system is supposed to be self-financing from the taxes.
Norwegian citizens living in Norway are automatically covered, even if they never had taxable income. Norwegian citizens living and working abroad (taxable elsewhere and therefore not paying the "public benefits fee" to Norway) are covered for up to one year after they move abroad, and must pay an estimated market cost for public health care services. Non-citizens like foreign visitors are covered in full.
According to WHO, total health care expenditure in 2005 was 9% of GDP and paid 84% by government, 15% by private out-of-pocket and ~1% by other private sources.
in 2000. Universal healthcare (including prescriptions and dental care) is provided automatically to all citizens and also to expatriates working in the public sector by the Ministry of Health. Non-eligible individuals such as expatriates working in the private sector and foreign visitors can be treated in the government hospitals and clinics for a reasonable fee or they can opt for the more expensive private clinics and medical centres. The Ministry of Health also finances the treatment of citizens abroad if the required treatment is not available in Oman. The life expectancy in Oman as of 2007 was 71.6. It had 1.81 doctors per 1000 pop., 1.9 beds per 1000 pop. and an infant mortality rate of 9 per 1000 live births. Health expenditure accounts for 4.5% of government revenue.
infrastructure are generally poor, particularly in rural areas. About 19 percent of the population is malnourished—a higher rate than the 17 percent average for developing countries—and 30 percent of children under age five are malnourished. Leading causes of sickness and death include gastroenteritis
, respiratory infections, congenital abnormalities, tuberculosis
, malaria
, and typhoid fever
. The United Nations
estimates that in 2003 Pakistan’s human immunodeficiency virus (HIV) prevalence rate was 0.1 percent among those 15–49, with an estimated 4,900 deaths from acquired immune deficiency syndrome (AIDS). AIDS is a major health concern, and both the government and religious community are engaging in efforts to reduce its spread. In 2003 there were 68 physicians for every 100,000 persons in Pakistan. According to 2002 government statistics, there were 12,501 health institutions nationwide, including 4,590 dispensaries, 906 hospitals with a total of 80,665 hospital beds, and 550 rural health centers with a total of 8,840 beds. According to the World Health Organization
, Pakistan’s total health expenditures amounted to 3.9 percent of gross domestic product (GDP) in 2001, and per capita health expenditures were US$16. The government provided 24.4 percent of total health expenditures, with the remainder being entirely private, out-of-pocket expenses.
ranks near the median among South America
n countries. In 2003 Paraguay
had a child mortality
rate of 29.5 deaths per 1,000 children, ranking it behind Argentina
, Colombia
, and Uruguay
but ahead of Brazil
and Bolivia
. The health of Paraguayans living outside urban areas is generally worse than those residing in cities. Many preventable diseases, such as Chagas' disease, run rampant in rural regions. Parasitic and respiratory diseases, which could be controlled with proper medical treatment, drag down Paraguay's overall health. In general, malnutrition
, lack of proper health care, and poor sanitation
are the root of many health problems in Paraguay.
Health care funding from the national government increased gradually throughout the 1980s and 1990s. Spending on health care rose to 1.7 percent of the gross domestic product
(GDP) in 2000, nearly triple the 0.6 percent of GDP spent in 1989. But during the past decade, improvement in health care has slowed. Paraguay spends less per capita (US$13−20 per year) than most other Latin American countries. A 2001 survey indicated that 27 percent of the population still had no access to medical care, public or private. Private health insurance is very limited, with pre-paid plans making up only 11 percent of private expenditures on health care. Thus, most of the money spent on private health care (about 88 percent) is on a fee-for-service basis, effectively preventing the poor population from seeing private doctors. According to recent estimates, Paraguay has about 117 physician
s and 20 nurses per 100,000 population.
found that China's health care system before 1980 performed far better than countries at a comparable level of development, since 1980 ranks much lower than comparable countries. The end of the famed "barefoot doctor" system was abolished in 1981.
China is undertaking a reform on its health care system
. The New Rural Co-operative Medical Care System (NRCMCS) is a new 2005 initiative to overhaul the health care 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.
Health care was provided in both rural and urban areas through a three-tiered system. In rural areas the first tier was made up of barefoot doctors working out of village medical centers. They provided preventive and primary-care services, with an average of two doctors per 1,000 people. At the next level were the township health centers, which functioned primarily as out-patient clinics for about 10,000 to 30,000 people each. These centers had about ten to thirty beds each, and the most qualified members of the staff were assistant doctors. The two lower-level tiers made up the "rural collective health system" that provided most of the country's medical care. Only the most seriously ill patients were referred to the third and final tier, the county hospitals, which served 200,000 to 600,000 people each and were staffed by senior doctors who held degrees from 5-year medical school
s. Health care in urban areas was provided by paramedical personnel assigned to factories and neighborhood health stations. If more professional care was necessary the patient was sent to a district hospital, and the most serious cases were handled by municipal hospitals. To ensure a higher level of care, a number of state enterprises and government agencies sent their employees directly to district or municipal hospitals, circumventing the paramedical, or barefoot doctor, stage.
had about 95,000 physician
s, or about 1 per 800 people. In 2001 there were about 1,700 hospital
s, of which about 40 percent were government-run and 60 percent private, with a total of about 85,000 beds, or about one bed per 900 people. The leading causes of morbidity as of 2002 were diarrhea
, bronchitis
, pneumonia
, influenza
, hypertension
, tuberculosis
, heart disease
, malaria
, chickenpox
, and measles
. Cardiovascular diseases account for more than 25 percent of all deaths. According to official estimates, 1,965 cases of human immunodeficiency virus (HIV) were reported in 2003, of which 636 had developed acquired immune deficiency syndrome (AIDS). Other estimates state that there may have been as many as 9,400 people living with HIV/AIDS in 2001.
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. He also said that obligatory medical insurance tax paid by companies will increase from current 3.1% to 5.1% starting from 2011.
is mainly under the responsibility of the Singapore Government's Ministry of Health
. Singapore generally has an efficient and widespread system of health care. It implements a universal health care
system, and co-exists with private health care system. Infant mortality
rate: in 2006 the crude birth rate stood at 10.1 per 1000, a very low level attributed to birth control policies, and the crude death rate was also one of the lowest in the world at 4.3 per 1000. In 2006, the total fertility rate was only 1.26 children per woman, the 3rd lowest in the world and well below the 2.10 needed to replace the population. Singapore was ranked 6th in the World Health Organization
's ranking of the world's health systems in the year 2000.
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. Singapore currently has the lowest infant mortality rate in the world (equaled only by Iceland) and among the highest life expectancies from birth, according to the World Health Organization
. Singapore has "one of the most successful health care 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
. Singapore's system uses a combination of compulsory savings from payroll deductions (funded by both employers and workers) a nationalized catastrophic health insurance plan, and government subsidies, as well as "actively regulating the supply and prices of health care 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.
Singapore’s well-established health care system comprises a total of 13 private hospitals, 10 public (government) hospitals and several specialist clinics, each specializing in and catering to different patient needs, at varying costs.
Patients are free to choose the providers within the government or private health care delivery system and can walk in for a consultation at any private clinic or any government polyclinic. For emergency services, patients can go at any time to the 24-hour Accident & Emergency Departments located in the government hospitals.
Singapore's medical facilities are among the finest in the world, with well qualified doctors and dentists, many trained overseas.
Singapore has medical savings account
system known as Medisave
.
, parallel private and public systems exist. The public system serves the vast majority of the population, but is chronically underfunded and understaffed. The wealthiest 20% of the population uses the private system and are far better served. This division in substantial ways perpetuates racial inequalities created in the pre-apartheid segregation era and apartheid era of the 20th century. In 2005, South Africa spent 8.7% of GDP on health care, or US$437 per capita. Of that, approximately 42% was government expenditure.
, helping account for a relatively low average life expectancy
of 57 years and an infant mortality
rate of 69 deaths per 1,000 live births, low by standards in Middle Eastern but not African countries. For most of the period since independence in 1956, Sudan has experienced civil war
, which has diverted resources to military use that otherwise might have gone into health care and training of professionals, many of whom have migrated in search of more gainful employment. In 1996 the World Health Organization
estimated that there were only 9 doctors per 100,000 people, most of them in regions other than the South. Substantial percentages of the population lack access to safe water and sanitary facilities. Malnutrition
is widespread outside the central Nile corridor because of population displacement from war and from recurrent droughts; these same factors together with a scarcity of medicines make diseases difficult to control. Child immunization against most major childhood diseases, however, had risen to approximately 60 percent by the late 1990s from very low rates in earlier decades. Spending on health care is quite low—only 1 percent of gross domestic product
(GDP) in 1998 (latest data). The United Nations
placed the rate of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) infection in late 2003 at 2.3 percent for adults, quite low by regional standards. The United Nations suggested, however, that the rate could be as high as 7.2 percent. Between 400,000 and 1.3 million adults and children were living with HIV, and AIDS deaths numbered 23,000. As of late 2004, some 4 million persons in the South had been internally displaced and more than 2 million had died or been killed as a result of two decades of war. Comparable figures for Darfur
were 1.6 million displaced and 70,000 dead since fighting began there in early 2003.
public health system is funded through taxes levied by the county councils
. There is a fixed charge of SEK 150 (USD 21) for each visit to a doctor or a hospital, limited to SEK 800 (USD 111) per year, and prescription charges are limited to 1,800 SEK (= 249 USD) per year. Government-paid dental care for children under 21 years old is included in the system, and dental care for grown-ups is partly subsidised by it.
Sweden also has a smaller private health care sector, mainly in larger cities or as centers for preventive health care financed by employers.
, compulsory health insurance
covers the costs of medical treatment and hospitalization of the insured. The Swiss healthcare system is a combination of public, subsidized private and totally private healthcare providers, where the insured person has full freedom of choice among the providers in his region. Insurance companies independently set their price points for different age groups, but are forbidden from setting prices based on health risk. In 2000, Switzerland topped all European countries’ health care expenditure when calculated as per capita expenditure in US dollar purchasing parity terms.
The Swiss health care system is interesting as it was the last for-profit system in Europe. In the 1990s, after the private carriers began to deny coverage for pre-existing conditions—and when the uninsured population of Switzerland reached 5%--the Swiss held a referendum (1995) and adopted their present system.
has placed an emphasis on health care
, but funding levels have not been able to keep up with demand or maintain quality. Health expenditures reportedly accounted for 2.5 percent of the gross domestic product
(GDP) in 2001. Syria’s health system is relatively decentralized and focuses on offering primary health care at three levels: village, district, and provincial. According to the World Health Organization
(WHO), in 1990 Syria had 41 general hospital
s (33 public, 8 private), 152 specialized hospitals (16 public, 136 private), 391 rural health centers, 151 urban health centers, 79 rural health units, and 49 specialized health centers; hospital bed
s totaled 13,164 (77 percent public, 23 percent private), or 11 beds per 10,000 inhabitants. The number of state hospital beds reportedly fell between 1995 and 2001, while the population had an 18 percent increase, but the opening of new hospitals in 2002 caused the number of hospital beds to double. WHO reported that in 1989 Syria had a total of 10,114 physician
s, 3,362 dentist
s, and 14,816 nurses and midwives; in 1995 the rate of health professionals per 10,000 inhabitants was 10.9 physicians, 5.6 dentists, and 21.2 nurses and midwives. Despite overall improvements, Syria’s health system exhibits significant regional disparities in the availability of health care, especially between urban and rural areas. The number of private hospitals and doctors increased by 41 percent between 1995 and 2001 as a result of growing demand and growing wealth in a small sector of society. Almost all private health facilities are located in large urban areas such as Damascus
, Aleppo
, Tartus, and Latakia
.
, 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. 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. Most health providers operate in the private sector and form a competitive market on the health delivery side. However, many health care providers took advantage of the system by offering unnecessary services to a larger number of patients and then billing the government. In the face of increasing loss and the need for cost containment , NHI changed the payment system from fee-for-service to a global budget, a kind of prospective payment system, in 2002.
According to T.R. Reid
, Taiwan achieves "remarkable efficiency", costing ~6 percent of GDP universal coverage
; however, this underestimates the cost as it is not fully funded and the government is forced to borrow to make up the difference. "And frankly, the solution is fairly obvious: increase the spending a little, to maybe 8 percent of GDP. Of course, if Taiwan did that, it would still be spending less than half of what America spends." And then, as with the American government Medicare and Medicaid, it would be "obvious" that the government spending needed to be increased every year. The "solution" to government borrowing being to increase government spending.
had 0.3 physicians and 1.9 hospital beds per 1,000 population. In 2002 annual spending on health care amounted to US$321 per person in purchasing power parity
(PPP). Total expenditures represented about 4.4 percent of the gross domestic product
(GDP); of this amount, 57.1 percent came from public sources and 42.9 percent from private sources. Some 85 percent of the population had access to potable water in 2002, and 99 percent had access to sanitation
. Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is a serious problem in Thailand. The United Nations Programme on HIV/AIDS (UNAIDS) reported in November 2004 that the Thai government had launched a well-funded, politically supported, and pragmatic response to the epidemic. As a result, national adult HIV prevalence has decreased to an estimated 1.5 percent of all persons aged 15 to 49 years (or about 1.8 percent of the total population). It was also reported that 58,000 adults and children had died from AIDS since the first case was reported in 1984. The government has begun to improve its support to persons with HIV/AIDS and has provided funds to HIV/AIDS support groups. Public programs have begun to alter unsafe behavior, but discrimination against those infected continues. The government has funded an antiretroviral drug program and, as of September 2006, more than 80,000 HIV/AIDS patients had received such drugs. Highly pathogenic H5N1 avian influenza (bird flu) has been found among birds in Thailand as well as surrounding areas. The government has pledged financial support for the prevention effort, which mainly focuses on changing poultry farming methods. Major infectious diseases in Thailand also include bacterial diarrhea
, hepatitis
, dengue fever
, malaria
, Japanese encephalitis
, rabies
, and leptospirosis
.
Thailand
introduced universal coverage reforms in 2001, becoming one of only a handful of lower-middle income countries to do so. 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. 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 state-paid. It is not yet clear whether the scheme will be modified further under the coalition government that came to power in January 2008.
operates under a two-tier health-care system. That is, there is the existence of both private health-care facilities and public health-care facilities.
The Ministry of Health is responsible for leading the health sector. The service provision aspect of public health care has been devolved to newly created entities, the Regional Health Authorities (RHAs). The Ministry of Health is shifting its focus to concentrate on policy development, planning, monitoring and evaluation, regulation, financing and research. Citizens can access government-paid health care at public health care facilities where health insurance is not required. The health-care system in the country is universal as almost all citizens utilise the services provided. Some, though, opt for private health-care facilities for their ailments.
Recently, the government of Trinidad and Tobago has launched CDAP (Chronic Disease Assistance Programme). The Chronic Disease Assistance Programme provides citizens with government-paid prescription drugs and other pharmaceutical items to combat several health conditions.
had 50 hospital beds per 10,000 population, less than half the number in 1996. Overall policy has targeted specialized inpatient facilities to the detriment of basic, outpatient care. Since the late 1990s, many rural facilities have closed, making care available principally in urban areas. President Niyazov’s 2005 proposal to close all hospitals outside Ashgabat intensified this trend. Physicians are poorly trained, modern medical techniques are rarely used, and medications are in short supply. In 2004 Niyazov dismissed 15,000 medical professionals, exacerbating the shortage of personnel. In some cases, professionals have been replaced by military conscripts. Private health care is rare, as the state maintains a near monopoly. Government-paid public health care was abolished in 2004.
have separate but co-operating public health care systems that were created in 1948: in England
the public health system is known as the National Health Service
, in Scotland
it is known as NHS Scotland
, in Wales
as NHS Wales (GIG Cymru), and in Northern Ireland
it is called Health and Social Care in Northern Ireland. All four provide state-paid healthcare to all UK residents, paid for from general taxation. Though the public systems dominate, private health care and a wide variety of alternative and complementary treatments are available for those who have private health insurance or are willing to pay directly themselves.
The main difference between the four public health care systems is the patient cost for prescriptions. Wales, Northern Ireland and Scotland have recently abolished, or are in the process of abolishing, all prescription charges, while England (with the exception of birth control pills, which are paid for by the state) continues to charge patients who are between 16 and 60 years old a fixed prescription fee of £7.40 per item, unless they are exempt because of certain medical conditions (including cancer) or are on low income. Since health care delivery is a devolved matter
, considerable differences are developing between the systems in each of the countries.
usually focuses around three suggested systems, with proposals currently underway to integrate these systems in various ways to provide a number of health care options. First is single-payer
, a term meant to describe a single agency managing a single system, as found in most modernized countries as well as some states and municipalities within the United States. Second are employer or individual insurance mandates. Finally, there is consumer-driven health, in which systems, consumers, and patients have more control of how they access care. Over the past thirty years, most of the nation's health care has moved from the second model operating with not-for-profit institutions to the third model operating with for-profit institutions.
In the US, the social and political issues surrounding access to health care have led to vigorous public debate and the almost colloquial use of terms such as health care (medical management of illness), health insurance
(reimbursement of health care costs), and public health
(the collective state and range of health in a population). In the US, 12% to 16% of the citizens do not have health insurance. State boards and the Department of Health regulate inpatient care to reduce the national health care deficit. To tackle the problems of the perpetually increasing number of uninsured, and costs associated with the US health care system, President Barack Obama
says he favors the creation of a universal health care system. However, this view is not shared across the country (see, for example, quotes from New York Times opinion columnist Paul Krugman
and Factcheck.org).
A few states have taken serious steps toward universal health care coverage, most notably Minnesota
, Massachusetts
and Connecticut
, with recent examples being the Massachusetts 2006 Health Reform Statute and Connecticut's SustiNet
plan to provide quality, affordable health care to state residents.
The state of Oregon and the city of San Francisco are both examples of governments that adopted universal healthcare systems for strictly fiscal reasons.
The United States is alone among developed nations in not having a universal health care
system; the 2010 Patient Protection and Affordable Care Act
provides for a nationwide health insurance exchange
by 2014, but this is not universal in the way similar countries mean it. Healthcare in the U.S. does, however, have significant publicly funded components. Medicare
covers the elderly and disabled with a historical work record, Medicaid
is available for some, but not all of the poor, and the State Children's Health Insurance Program
covers children of low-income families. The Veterans Health Administration
directly provides health care to U.S. military veterans through a nationwide network of government hospitals; while active duty service members, retired service members and their dependents are eligible for benefits through TRICARE
. Together, these tax-financed programs cover 27.8% of the population and make the government the largest health insurer in the nation.
, resulting from increased government spending during strong economic years. According to the UAE government, total expenditures on health care from 1996 to 2003 were US$436 million. According to the World Health Organization
, in 2004 total expenditures on health care constituted 2.9 percent of gross domestic product
(GDP), and the per capita expenditure for health care was US$497. Health care currently is government-paid only for UAE citizens. Effective January 2006, all residents of Abu Dhabi
are covered by a new comprehensive health insurance program; costs will be shared between employers and employees. The number of doctors
per 100,000 (annual average, 1990–99) is 181. The UAE now has 40 public hospitals, compared with only seven in 1970. The Ministry of Health is undertaking a multimillion-dollar program to expand health facilities⎯hospitals, medical centers, and a trauma center⎯in the seven emirates. A state-of-the-art general hospital has opened in Abu Dhabi with a projected bed capacity of 143, a trauma unit, and the first home health care program in the UAE. To attract wealthy UAE nationals and expatriates who traditionally have traveled abroad for serious medical care, Dubai is developing Dubai Healthcare City, a hospital free zone that will offer international-standard advanced private health care and provide an academic medical training center; completion is scheduled for 2010.
’s health care
has declined. Between 1992 and 2003, spending on health care and the ratio of hospital beds to population both decreased by nearly 50 percent, and Russian emigration
in that decade deprived the health system of many practitioners. In 2004 Uzbekistan had 53 hospital beds per 10,000 population. Basic medical supplies such as disposable needle
s, anesthetics, and antibiotics are in very short supply. Although all citizens nominally are entitled to free health care, in the post-Soviet era bribery
has become a common way to bypass the slow and limited service of the state system. In the early 2000s, policy has focused on improving primary health care facilities and cutting the cost of inpatient facilities. The state budget for 2006 allotted 11.1 percent to health expenditures, compared with 10.9 percent in 2005.
is regarded as good, as reflected by 2005 estimates of life expectancy
(70.61 years) and infant mortality (25.95 per 1,000 live births). However, malnutrition
is still common in the provinces, and the life expectancy and infant mortality
rates are stagnating. In 2001 government spending on health care corresponded to just 0.9 percent of gross domestic product
(GDP). Government subsidies covered only about 20 percent of health care expenses, with the remaining 80 percent coming out of individuals’ own pockets.
In 1954 the government in the North established a public health system that reached down to the hamlet level. After reunification in 1976, this system was extended to the South. Beginning in the late 1980s, the quality of health care began to decline as a result of budgetary constraints, a shift of responsibility to the provinces, and the introduction of charges. Inadequate funding has led to delays in planned upgrades to water supply
and sewage
systems. As a result, almost half the population has no access to clean water, a deficiency that promotes such infectious diseases as malaria
, dengue fever
, typhoid, and cholera
. Inadequate funding also has contributed to a shortage of nurses, midwives, and hospital beds. In 2000 Vietnam had only 250,000 hospital beds, or 14.8 beds per 10,000 people, a very low ratio among Asian nations, according to the World Bank
.
has made to expand and improve its health care system over the past decade, the system remains severely underdeveloped. Total expenditures on health care in 2002 constituted 3.7 percent of gross domestic product
. In that same year, the per capita expenditure for health care was very low, as compared with other Middle East
ern countries—US$58 according to United Nations
statistics and US$23 according to the World Health Organization
. According to the World Bank
, the number of doctors
in Yemen rose by an average of more than 7 percent between 1995 and 2000, but as of 2004 there were still only three doctors per 10,000 persons. In 2003 Yemen had only 0.6 hospital beds available per 1,000 persons. Health care services are particularly scarce in rural areas; only 25 percent of rural areas are covered by health services, as compared with 80 percent of urban areas. Emergency services, such as ambulance
service and blood banks, are non-existent. Most childhood deaths are caused by illnesses for which vaccines exist or that are otherwise preventable. According to the Joint United Nations Programme on HIV/AIDS
, in 2003 an estimated 12,000 people in Yemen were living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS).
. Infant mortality
has risen from 59 per thousand in the late 1990s to 123 per 1000 by 2004. The health system has more or less collapsed: By the end of November 2008, three of Zimbabwe's four major hospital
s had shut down, along with the Zimbabwe Medical School
and the fourth major hospital had two wards and no operating theatre
s working. Due to hyperinflation
, those hospitals still open are not able to obtain basic drugs and medicine
s. The ongoing political and economic crisis also contributed to the emigration
of the doctors and people with medical knowledge. In August 2008, large areas of Zimbabwe were struck by the ongoing cholera
epidemic
.
Organization
An organization is a social group which distributes tasks for a collective goal. The word itself is derived from the Greek word organon, itself derived from the better-known word ergon - as we know `organ` - and it means a compartment for a particular job.There are a variety of legal types of...
of people, institutions, and resources to deliver health care
Health care
Health care 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...
services to meet the health
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
needs of target populations.
There is a wide variety of health care systems around the world, with as many histories and organizational structures as there are nations. In some countries, health care system planning is distributed among market participants. In others, there is a concerted effort among government
Government
Government refers to the legislators, administrators, and arbitrators in the administrative bureaucracy who control a state at a given time, and to the system of government by which they are organized...
s, 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.
Goals
The goals for health systems, according to the World Health OrganizationWorld Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
, 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
Health care provider
A health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....
, resource generation, financing, and stewardship. Other dimensions for the evaluation of health care systems include quality, efficiency, acceptability, and equity
Health equity
Health equity refers to the study of differences in the quality of health and health care across different populations....
. They have also been described in the United States as "the five C's": Cost, Coverage, Consistency, Complexity, and Chronic Illness. Also, continuity of health care is a major goal.
Providers
Health care providers are institutions or individuals providing health care services. Individuals including health professionals and allied health professionsAllied health professions
Allied health professions are clinical health care professions distinct from dentistry, nursing and medicine. One estimate reported allied health professionals make up 60 percent of the total health workforce...
can be self-employed or working as an employee in a hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
, clinic
Clinic
A clinic is a health care facility that is primarily devoted to the care of outpatients...
, 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
Health department
A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their own...
or other agency, medical laboratory
Medical laboratory
A medical laboratory or clinical laboratory is a laboratory where tests are done on clinical specimens in order to get information about the health of a patient as pertaining to the diagnosis, treatment, and prevention of disease.-Departments:...
, or health training institution. Examples of health workers
Health Human Resources
Health human resources — also known as “human resources for health” or “health workforce” — is defined as “all people engaged in actions whose primary intent is to enhance health”, according to the World Health Organization's World Health Report 2006. Human resources for health are identified as...
are doctors
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
, nurses
Nursing
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....
, midwives
Midwifery
Midwifery is a health care profession in which providers offer care to childbearing women during pregnancy, labour and birth, and during the postpartum period. They also help care for the newborn and assist the mother with breastfeeding....
, paramedic
Paramedic
A paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...
s, dentist
Dentist
A dentist, also known as a 'dental surgeon', is a doctor that specializes in the diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aides in providing oral health services...
s, medical laboratory technologists, therapists, psychologist
Psychologist
Psychologist is a professional or academic title used by individuals who are either:* Clinical professionals who work with patients in a variety of therapeutic contexts .* Scientists conducting psychological research or teaching psychology in a college...
s, pharmacist
Pharmacist
Pharmacists are allied health professionals who practice in pharmacy, the field of health sciences focusing on safe and effective medication use...
s, chiropractors
Chiropractic
Chiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. It is generally categorized as complementary and alternative medicine...
, optometrists
Optometry
Optometry is a health care profession concerned with eyes and related structures, as well as vision, visual systems, and vision information processing in humans. Optometrists, or Doctors of Optometry, are state licensed medical professionals trained to prescribe and fit lenses to improve vision,...
, community health worker
Community health worker
Community health workers are members of a community who are chosen by community members or organizations to provide basic health and medical care to their community...
s, traditional medicine practitioners, and others.
Financial resources
- general taxation to the state, county or municipality
- social health insuranceSocial insuranceSocial insurance is any government-sponsored program with the following four characteristics:* the benefits, eligibility requirements and other aspects of the program are defined by statute;...
- voluntary or private health insuranceHealth insuranceHealth insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
- out-of-pocket paymentsOut-of-pocket expensesOut-of-pocket expenses are direct outlays of cash which may or may not be later reimbursed.In operating a vehicle, gasoline, parking fees and tolls are considered out-of-pocket expenses for the trip...
- donationDonationA donation is a gift given by physical or legal persons, typically for charitable purposes and/or to benefit a cause. A donation may take various forms, including cash, services, new or used goods including clothing, toys, food, and vehicles...
s to charities
Most countries' systems feature a mix of all five models. One study based on data from the OECD concluded that all types of health care finance "are compatible with" an efficient health care system. The study also found no relationship between financing and cost control.
The term health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
is generally used to describe a form of insurance
Insurance
In law and economics, insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for payment. An insurer is a company selling the...
that pays for medical expenses. It is sometimes used more broadly to include insurance covering disability
Disability insurance
Disability Insurance, often called DI or disability income insurance, is a form of insurance that insures the beneficiary's earned income against the risk that a disability will make working uncomfortable , painful , or impossible...
or long-term nursing or custodial care
Long term care insurance
Long-term care insurance , an insurance product sold in the United States, United Kingdom and Canada, helps provide for the cost of long-term care beyond a predetermined period...
needs. It may be provided through a social insurance
Social insurance
Social insurance is any government-sponsored program with the following four characteristics:* the benefits, eligibility requirements and other aspects of the program are defined by statute;...
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.
Many forms of commercial health insurance control their costs by restricting the benefits that are paid by through deductible
Deductible
In an insurance policy, the deductible is the amount of expenses that must be paid out of pocket before an insurer will pay any expenses. It is normally quoted as a fixed quantity and is a part of most policies covering losses to the policy holder. The deductible must be paid by the insured,...
s, co-payments, coinsurance
Coinsurance
Co-insurance is an insurance-related term that describes a splitting or spreading of risk among multiple parties.-In the United States:In the US insurance market, coinsurance is the joint assumption of risk between the insurer and the insured...
, 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
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.-History:...
, 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
Innovative financing
Innovative financing refers to a range of non-traditional mechanisms to raise additional funds for development aid through "innovative" projects such as micro-contributions, taxes, public-private partnerships and market-based financial transactions....
mechanisms for scaling up delivery and sustainability of health care, such as micro-contributions, public-private partnership
Public-private partnership
Public–private partnership describes a government service or private business venture which is funded and operated through a partnership of government and one or more private sector companies...
s, and market-based financial transaction tax
Financial transaction tax
A financial transaction tax is a tax placed on a specific type of financial transaction for a specific purpose.This term has been most commonly associated with the financial sector, as opposed to consumption taxes paid by consumers. However, it is not a taxing of the financial institutions themselves...
es. For example, as of June 2011, UNITAID
Unitaid
UNITAID is an international facility for the purchase of drugs against HIV/AIDS, Malaria and Tuberculosis. It was founded in September 2006 on the initiative of Brazil and France, and is to a great part financed by so called innovative development financing mechanisms, namely a solidarity levy on...
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.
Payment models
In most countries, wageWage
A wage is a compensation, usually financial, received by workers in exchange for their labor.Compensation in terms of wages is given to workers and compensation in terms of salary is given to employees...
costs for health care practitioners are estimated to represent between 65% and 80% of renewable health system expenditures. There are three ways to pay medical practitioners. There has been growing interest in blending elements of these systems.
Fee-for-service
Fee-for-serviceFee-for-service
Fee-for-service is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care...
arrangements pay general practitioner
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
s (GPs) based on the service. They are even more
widely used for specialists working in ambulatory care
Ambulatory care
Ambulatory care is a personal health care consultation, treatment or intervention using advanced medical technology or procedures delivered on an outpatient basis Ambulatory care is a personal health care consultation, treatment or intervention using advanced medical technology or procedures...
.
There are two ways to set fee levels:
- 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.
Other
In capitation payment systemsCapitation (healthcare)
Capitation, is a method of paying health care service providers a set amount for each enrolled person assigned to that physician or group of physicians, whether or not that person seeks care, per period of time....
, GPs are paid for each patient on their "list", usually with adjustments for factors such as age and gender. 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."
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."
In several OECD countries, general practitioners (GPs) are employed on salaries
Salary
A salary is a form of periodic payment from an employer to an employee, which may be specified in an employment contract. It is contrasted with piece wages, where each job, hour or other unit is paid separately, rather than on a periodic basis....
for the government. 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." There has been movement away from this system.
Information resources
Sound information plays an increasingly critical role in the delivery of modern health care and efficiency of health care systems. Health informatics - the intersection of information scienceInformation science
-Introduction:Information science is an interdisciplinary science primarily concerned with the analysis, collection, classification, manipulation, storage, retrieval and dissemination of information...
, medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
and health care
Health care
Health care 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...
- deals with the resources, devices, and methods required to optimize the acquisition and use of information in health and biomedicine. Necessary tools for proper health information coding and management include clinical guidelines, formal medical terminologies
Medical terminology
Medical terminology is a vocabulary for accurately describing the human body and associated components, conditions, processes and process in a science-based manner. Some examples are: R.I.C.E., trapezius, and latissimus dorsi. It is to be used in the medical and nursing fields...
, and computers and other information and communication technologies. The kinds of data processed may include patients' medical records, hospital administration and clinical functions
Hospital information system
There are various titles and acronyms which all declare similar approaches to managing the information flow and storage in hospital routine services, as*Hospital Information System , or*Healthcare Information System, or...
, and human resources information
HRHIS
A “Human Resource for Health Information System” — also known within the health care sector as “human resource information system” — is a system for collecting, processing, managing and disseminating data and information on human resource for health...
.
The use of health information lies at the root of evidence-based policy
Evidence-based policy
Evidence-based policy is public policy informed by rigorously established objective evidence. It is an extension of the idea of evidence-based medicine to all areas of public policy...
and evidence-based management
Evidence-based management
Evidence-based management is an emerging movement to explicitly use the current, best evidence in management decision-making. Its roots are in evidence-based medicine, a quality movement to apply the scientific method to medical practice....
in health care.
Management
The management of any health care system is typically directed through a set of policies and plans adopted by government, private sector business and other groups in areas such as personal health care delivery and financing, pharmaceuticalsPharmaceutical policy
Pharmaceutical policy is a branch of health policy that deals with the development, provision and use of medications within a health care system. It embraces drugs , biologics , vaccines and natural health products...
, health human resources
Health Human Resources
Health human resources — also known as “human resources for health” or “health workforce” — is defined as “all people engaged in actions whose primary intent is to enhance health”, according to the World Health Organization's World Health Report 2006. Human resources for health are identified as...
, and public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
.
Public health is concerned with threats to the overall health of a community based on population health
Population health
Population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” It is an approach to health that aims to improve the health of an entire population. One major step in achieving this aim is to reduce health...
analysis. The population in question can be as small as a handful of people, or as large as all the inhabitants of several continents (for instance, in the case of a pandemic
Pandemic
A pandemic is an epidemic of infectious disease that is spreading through human populations across a large region; for instance multiple continents, or even worldwide. A widespread endemic disease that is stable in terms of how many people are getting sick from it is not a pandemic...
). Public health is typically divided into epidemiology
Epidemiology
Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...
, biostatistics
Biostatistics
Biostatistics is the application of statistics to a wide range of topics in biology...
and health services. Environmental
Environmental health
Environmental health is the branch of public health that is concerned with all aspects of the natural and built environment that may affect human health...
, social, behavioral
Behavioral health
In psychology behavioral health, as a general concept, refers to the reciprocal relationship between human behavior, individually or socially, and the well-being of the body, mind, and spirit, whether the latter are considered individually or as an integrated whole...
, and occupational health are also important subfields.
Health equity
Health equity refers to the study of differences in the quality of health and health care across different populations....
, although public health generally receives significantly less government funding compared with medicine. For example, most countries have a vaccination policy
Vaccination policy
Vaccination policy refers to the health policy a government adopts in relation to vaccination. Vaccinations are voluntary in some countries and mandatory in some countries as part of the public health system...
, supporting public health programs in providing vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
s 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
Chronic care management
Chronic care management encompasses the oversight and education activities conducted by health care professionals to help patients with chronic diseases and health conditions such as diabetes, high blood pressure, lupus, multiple sclerosis and sleep apnea learn to understand their condition and...
, 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. Another major public health concern is diabetes. 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
Tobacco smoking
Tobacco smoking is the practice where tobacco is burned and the resulting smoke is inhaled. The practice may have begun as early as 5000–3000 BCE. Tobacco was introduced to Eurasia in the late 16th century where it followed common trade routes...
, linked to cancer and other chronic illnesses.
Antibiotic resistance
Antibiotic resistance
Antibiotic resistance is a type of drug resistance where a microorganism is able to survive exposure to an antibiotic. While a spontaneous or induced genetic mutation in bacteria may confer resistance to antimicrobial drugs, genes that confer resistance can be transferred between bacteria in a...
is another major concern, leading to the reemergence of diseases such as tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
. The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
, for its World Health Day 2011
World Health Day
World Health Day is celebrated every year on 7 April, under the sponsorship of the World Health Organization .In 1948, the World Health Organization held the First World Health Assembly. The Assembly decided to celebrate 7 April of each year, with effect from 1950, as the World Health Day...
campaign, is calling for intensified global commitment to safeguard antibiotics and other antimicrobial
Antimicrobial
An anti-microbial is a substance that kills or inhibits the growth of microorganisms such as bacteria, fungi, or protozoans. Antimicrobial drugs either kill microbes or prevent the growth of microbes...
medicines for future generations.
Special health care topics
- Health careHealth careHealth care 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...
/ Health care management / Health care providerHealth care providerA health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities.... - Health center / ClinicClinicA clinic is a health care facility that is primarily devoted to the care of outpatients...
/ HospitalHospitalA hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays.... - MedicineMedicineMedicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
/ Doctor's visitDoctor's visitA doctor's visit, also known as "doctor's office visit" or "physician office visit", is a meeting between a patient with a physician to get health advice or treatment for a symptom or condition...
/ NursingNursingNursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death.... - Philosophy of healthcarePhilosophy of healthcareThe philosophy of healthcare is the study of the ethics, processes, and people which constitute the maintenance of health for human beings. For the most part, however, the philosophy of healthcare is best approached as an indelible component...
- Community health service
- Direct primary careDirect primary careIn the USA Direct Primary Care is primary care offered direct to the consumer, without insurance intervention. It is an umbrella term which incorporates various health care delivery systems that involve direct financial relationships between patients and health care providers.One niche variant of...
- Family medicineFamily medicineFamily medicine is a medical specialty devoted to comprehensive health care for people of all ages. It is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, sexes, diseases, and parts of the body...
/ Preventive medicinePreventive medicinePreventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...
/ Social medicineSocial medicineThe field of social medicine seeks to:# understand how social and economic conditions impact health, disease and the practice of medicine and# foster conditions in which this understanding can lead to a healthier society.... - Military medicineMilitary medicineThe term military medicine has a number of potential connotations. It may mean:*A medical specialty, specifically a branch of occupational medicine attending to the medical risks and needs of soldiers, sailors and other service members...
- Occupational safety and healthOccupational safety and healthOccupational safety and health is a cross-disciplinary area concerned with protecting the safety, health and welfare of people engaged in work or employment. The goal of all occupational safety and health programs is to foster a safe work environment...
- School health servicesSchool health servicesSchool health services are services from medical, teaching and other professionals applied in or out of school to improve the health and well-being of children and in some cases whole families...
- Social service / Social determinants of healthSocial determinants of healthSocial determinants of health are the economic and social conditions under which people live which determine their health. They are "societal risk conditions", rather than individual risk factors that either increase or decrease the risk for a disease, for example for cardiovascular disease and...
- Universal health careUniversal health careUniversal 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.-History:...
- Health policy
- Health insuranceHealth insuranceHealth insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
/ InsuranceInsuranceIn law and economics, insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for payment. An insurer is a company selling the...
/ Social health insurance / Subsidies - Health care reformHealth care reformHealth care reform is a general rubric used for discussing major health policy creation or changes—for the most part, governmental policy that affects health care delivery in a given place...
/ Health care reform in the United StatesHealth care reform in the United StatesHealth care reform in the United States has a long history, of which the most recent results were two federal statutes enacted in 2010: the Patient Protection and Affordable Care Act , signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010 , which amended the PPACA and... - Healthy cityHealthy cityHealthy city is a term used in public health and urban design to stress the impact of policy on human health. Its modern form derives from a World Health Organization initiative on Healthy Cities and Villages in 1986, but has a history dating back to the mid 19th century...
/ Alliance for Healthy CitiesAlliance for Healthy CitiesThe Alliance for Healthy Cities is a cooperative international alliance aimed at protecting and enhancing the health and health care of city dwellers. It is composed of groups of cities, urban districts and other organizations from countries around the world in exchanging information to achieve...
- Health insurance
Cross-country comparisons
Direct comparisons of health statistics across nations are complex. The Commonwealth FundCommonwealth Fund
The Commonwealth Fund is a private U.S. foundation whose stated purpose is to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, especially for society's most vulnerable.-History:...
, in its annual survey, "Mirror, Mirror on the Wall", compares the performance of the health care 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. 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
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.-History:...
. The OECD also collects comparative statistics, and has published brief country profiles.
The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
, in its World Health Report 2000
World Health Report
The World Health Report is a series of reports produced regularly by the World Health Organization . First published in 1995, the World Health Report is WHO's leading publication...
, provided a ranking of health care systems
WHO's ranking of health care systems
The World Health Organization ranked the healthcare systems of its 191 member states in its World Health Report 2000. It provided a framework and measurement approach to examine and compare aspects of health systems around the world...
around the world according to criteria of the overall level and distribution of health
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
in the populations, and the responsiveness and fair financing of health care services.
| Country | Life expectancy Life expectancy Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience... |
Infant mortality Infant mortality Infant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying... rate |
Physician Physician A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments... s per 1000 people |
Nurses per 1000 people | Per capita expenditure on health (USD) | Healthcare costs as a percent of GDP Gross domestic product Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living.... |
% of government revenue spent on health | % of health costs paid by government |
|---|---|---|---|---|---|---|---|---|
| Australia Health care in Australia Health care in Australia is provided by both private and government institutions. The Minister for Health and Ageing, currently Nicola Roxon, administers national health policy... |
81.4 | 4.2 | 2.8 | 9.7 | 3,137 | 8.7 | 17.7 | 67.7 |
| Canada Health care in Canada Health care in Canada is delivered through a publicly-funded health care system, which is mostly free at the point of use and has most services provided by private entities. It is guided by the provisions of the Canada Health Act. The government assures the quality of care through federal standards... |
81.4 | 3.9 | 2.3 | 9.0 | 3,895 | 10.1 | 16.7 | 69.8 |
| France Health care in France The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the "best overall health care" in the world... |
81.0 | 4.0 | 3.4 | 7.7 | 3,601 | 11.0 | 14.2 | 79.0 |
| Germany | 79.8 | 3.8 | 3.5 | 9.9 | 3,588 | 10.4 | 17.6 | 76.9 |
| Japan Health care in Japan The health care system in Japan provides healthcare services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%... |
82.6 | 2.6 | 2.1 | 9.4 | 2,581 | 8.1 | 16.8 | 81.3 |
| Norway Norway Norway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million... |
80.0 | 3.0 | 3.8 | 16.2 | 5,910 | 9.0 | 17.9 | 83.6 |
| Sweden | 81.0 | 2.5 | 3.6 | 10.8 | 3,323 | 9.2 | 13.6 | 81.7 |
| UK | 80.1 | 4.8 | 2.5 | 10.0 | 2,992 | 8.4 | 15.8 | 81.7 |
| USA Health care in the United States Health care in the United States is provided by many separate legal entities. Health care facilities are largely owned and operated by the private sector... |
78.1 | 6.7 | 2.4 | 10.6 | 7,290 | 16.0 | 18.5 | 45.4 |
Life Expectancy vs Health Care Spending in 2007 for OECD Countries. The data source is http://www.oecd.org.
Afghanistan
Beginning in 1979, military conflictSoviet war in Afghanistan
The Soviet war in Afghanistan was a nine-year conflict involving the Soviet Union, supporting the Marxist-Leninist government of the Democratic Republic of Afghanistan against the Afghan Mujahideen and foreign "Arab–Afghan" volunteers...
destroyed the health
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
system of Afghanistan
Afghanistan
Afghanistan , officially the Islamic Republic of Afghanistan, is a landlocked country located in the centre of Asia, forming South Asia, Central Asia and the Middle East. With a population of about 29 million, it has an area of , making it the 42nd most populous and 41st largest nation in the world...
. Most medical professionals left the country in the 1980s and 1990s, and all medical training programmes ceased. In 2004 Afghanistan had one medical facility for every 27,000 people, and some centers were responsible for as many as 300,000 people. In 2004 international organizations provided a large share of medical care. An estimated one-quarter of the population had no access to health care. In 2003 there were 11 physicians and 18 nurses per 100,000 population, and the per capita health expenditure was US$28.
Algeria
Health in AlgeriaHealth in Algeria
Health in Algeria, according to information from a March 6, 2006 United States report, does not compare well with the developed world. Algeria has inadequate numbers of physicians and hospital beds and poor access to water and sanitation...
, according to information from a March 6, 2006 United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
report, does not compare well with the developed world. Algeria
Algeria
Algeria , officially the People's Democratic Republic of Algeria , also formally referred to as the Democratic and Popular Republic of Algeria, is a country in the Maghreb region of Northwest Africa with Algiers as its capital.In terms of land area, it is the largest country in Africa and the Arab...
has inadequate numbers of physicians (one per 1,000 people) and hospital beds (2.1 per 1,000 people) and poor access to water (87 percent of the population) and sanitation
Sanitation
Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of wastes. Hazards can be either physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems are human and animal feces, solid wastes, domestic...
(92 percent of the population). Given Algeria’s young population, policy favors preventive health care
Health care
Health care 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...
and clinics over hospitals. In keeping with this policy, the government maintains an immunization
Immunization
Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an agent ....
program. However, poor sanitation and unclean water still cause tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
, hepatitis
Hepatitis
Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...
, measles
Measles
Measles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...
, typhoid fever
Typhoid fever
Typhoid fever, also known as Typhoid, is a common worldwide bacterial disease, transmitted by the ingestion of food or water contaminated with the feces of an infected person, which contain the bacterium Salmonella enterica, serovar Typhi...
, cholera
Cholera
Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces...
, and dysentery
Dysentery
Dysentery is an inflammatory disorder of the intestine, especially of the colon, that results in severe diarrhea containing mucus and/or blood in the faeces with fever and abdominal pain. If left untreated, dysentery can be fatal.There are differences between dysentery and normal bloody diarrhoea...
. In 2003 about 0.10 percent of the population aged 15–49 was living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
/AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
). The poor generally receive health care [aid for by the government, but the wealthy pay for care according to a sliding scale. Access to health care is enhanced by the requirement that doctors and dentists work in public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
for at least five years. However, doctors are more easily found in the cities of the north than in the southern Sahara
Sahara
The Sahara is the world's second largest desert, after Antarctica. At over , it covers most of Northern Africa, making it almost as large as Europe or the United States. The Sahara stretches from the Red Sea, including parts of the Mediterranean coasts, to the outskirts of the Atlantic Ocean...
region.
Argentina
ArgentinaArgentina
Argentina , officially the Argentine Republic , is the second largest country in South America by land area, after Brazil. It is constituted as a federation of 23 provinces and an autonomous city, Buenos Aires...
’s health care system is composed of three sectors: the public sector
Public sector
The public sector, sometimes referred to as the state sector, is a part of the state that deals with either the production, delivery and allocation of goods and services by and for the government or its citizens, whether national, regional or local/municipal.Examples of public sector activity range...
, financed through tax
Tax
To tax is to impose a financial charge or other levy upon a taxpayer by a state or the functional equivalent of a state such that failure to pay is punishable by law. Taxes are also imposed by many subnational entities...
es; the private sector
Private sector
In economics, the private sector is that part of the economy, sometimes referred to as the citizen sector, which is run by private individuals or groups, usually as a means of enterprise for profit, and is not controlled by the state...
, financed through voluntary insurance schemes
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
; and the social security
Social security
Social security is primarily a social insurance program providing social protection or protection against socially recognized conditions, including poverty, old age, disability, unemployment and others. Social security may refer to:...
sector, financed through obligatory insurance schemes. The Ministry of Health and Social Action (MSAS), oversees all three subsectors of the health care system and is responsible for setting of regulation, evaluation and collecting statistics.
Argentina has three sectors. The public sector is funded and managed by Obras Sociales, umbrella organizations for Argentine worker's unions. There are over 300 Obras Sociales in Argentina, each chapter being organized according to the occupation of the beneficiary. These organizations vary greatly in quality and effectiveness. The top 30 chapters hold 73% of the beneficiaries and 75% of resources for all Obras Sociales schemes and the monthly average a beneficiary receives varies from $5–80 per month. MSAS has established a Solidarity Redistribution Fund (FSR) to try to address these beneficiary inequities. Only workers employed in the formal sector are covered under Obras Sociales insurance schemes and after Argentina’s economic crisis of 2001
Argentine economic crisis (1999-2002)
The Argentine economic crisis was a financial situation, tied to poilitical unrest, that affected Argentina's economy during the late 1990s and early 2000s...
, the number of those covered under these schemes fell slightly (as unemployment increased and employment in the informal sector rose). In 1999, there were 8.9 million beneficiaries covered by Obras Sociales. The private health care sector in Argentina is characterized by great heterogeneity and is made up of a great number of fragmented facilities and small networks; it consists of over 200 organizations and covers approximately 2 million Argentines. Private insurance often overlaps with other forms of health care coverage, thus it is difficult to estimate the degree to which beneficiaries are dependent on the public and private sectors. According to a 2000 report by the IRBC, foreign competition
Competition (economics)
Competition in economics is a term that encompasses the notion of individuals and firms striving for a greater share of a market to sell or buy goods and services...
has increased in Argentina’s private sector, with Swiss
Switzerland
Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....
, American and other Latin America
Latin America
Latin America is a region of the Americas where Romance languages – particularly Spanish and Portuguese, and variably French – are primarily spoken. Latin America has an area of approximately 21,069,500 km² , almost 3.9% of the Earth's surface or 14.1% of its land surface area...
n health care provider
Health care provider
A health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....
s entering the market
Market
A market is one of many varieties of systems, institutions, procedures, social relations and infrastructures whereby parties engage in exchange. While parties may exchange goods and services by barter, most markets rely on sellers offering their goods or services in exchange for money from buyers...
in recent years. This has been accompanied by little formal regulation. The public system serves those not covered by Obras Sociales or private insurance schemes. It also provides emergency services
Emergency department
An emergency department , also known as accident & emergency , emergency room , emergency ward , or casualty department is a medical treatment facility specialising in acute care of patients who present without prior appointment, either by their own means or by ambulance...
. According to above-mentioned IRBC report, Argentina’s public system exhibits serious structural deterioration and managerial inefficiency; a high degree of administrative centralization at the provincial level
Provinces of Argentina
Argentina is subdivided into twenty-three provinces and one autonomous city...
; rigidity in its staffing structure and labour relationships; no adequate system of incentives; inadequate information systems on which to base decision-making and control; serious deficits in facilities and equipment maintenance; and a system of management ill-suited to its size. The public system is highly decentralized to the provincial level; often primary care
Primary care
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...
is even under the purview of local townships. Since 2001, the number of Argentines relying on public services has seen an increase. According to 2000 figures, 37.4% of Argentines had no health insurance, 48.8 were covered under Obras Sociales, 8.6% had private insurance, and 3.8% were covered by both Obras Sociales and private insurance schemes.
Australia
In AustraliaAustralia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
the current system, known as Medicare
Medicare (Australia)
Medicare is Australia's publicly funded universal health care system, operated by the government authority Medicare Australia. Medicare is intended to provide affordable treatment by doctors and in public hospitals for all resident citizens and permanent residents except for those on Norfolk Island...
, was instituted in 1984. It coexists with a private health system. All legal permanent residents are entitled to government-paid public hospital care. Treatment by private doctors is also paid by the government when the doctor direct bills the Health Department (Bulk Billing). Medicare is funded partly by a 1.5% income tax levy (with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. There is an uncapped 30% subsidy on private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme
Pharmaceutical Benefits Scheme
The Pharmaceutical Benefits Scheme or PBS is a program of the Australian Government that provides subsidised prescription drugs to residents of Australia. The PBS ensures that all Australians have affordable and reliable access to a wide range of necessary medicines.-History:The PBS was established...
under which listing and a government subsidy is dependent on expert evaluation of the comparative cost-effectiveness of new pharmaceuticals. In 2005, Australia spent 8.8% of GDP
Gross domestic product
Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....
on health care, or US$3,181 per capita. Of that, approximately 67% was government expenditure.
Belgium
As in most countries, the system divides itself into state and private, though fees are payable in both. A person needs to have adequate coverage through either the state insurance or through private insurance. In the state mutuelle/mutualiteit scheme a person has the ability to choose any doctor, clinic or hospital you like, in any location and without referral, according to your needs in much the same way as you can with private insurance.- Doctors
General practitioners can be found in private practices or attached to clinics and hospitals. A person is free to consult or register with any of their own choosing. Similarly with specialist consultants. Consultations usually end with a handing over of money and very few doctors offer payment by card of any type. Reimbursements are available for those with insurance, either private or public. If a patient is on a private scheme, or is uninsured, the fee is payable in full at the time of the appointment.
The majority of dentists in Belgium are private, though there are those who accept part-payment on state insurance.
As with general practitioners, people in Belgium can arrange to see a specialist of choice at any hospital. Those going into hospital for a planned stay need to take personal care items such as a towel and soap with them as these are not generally provided.
In Brussels the eleven big public hospitals are organized under the Iris association. http://www.iris-hopitaux.be/)
- Alternative health care
The Ministry of Health recognizes homeopathy, acupuncture, osteopathy and chiropractic as reimbursable alternative treatments. Reimbursement is possible only if the practitioner is registered as a qualified doctor.
- Emergency treatment
If a call is made to the Emergency services using the old emergency 100 or the common European 112 telephone number, an ambulance will take transport the patient to the nearest emergency centre or the best centre suited according to need, for example, a specialist burns unit.
- Pharmacies
Pharmacies are ubiquitous in Belgium, with the green cross sign everywhere. There is a rota system for chemists to open outside of usual hours and through the night.
- Insurance
Health care insurance is a part of the Belgian social security system. To benefit a person must join a health insurance fund mutuelle (mutualité) or ziekenfonds (mutualiteit) for which an employer's certificate is required if the employer is to contribute to the cost. If employed a person's contributions is automatically deducted from salary. The employer will also pay a contribution. Health insurance funds will reimburse medical costs. The choice of mutual insurer is up to the individual. Most of them are affiliated to a religious or political institution but there is no real difference between them because reimbursement rates are fixed by the Belgian government.
Insurance funds do not cover 100 per cent of your bills and typical reimbursement is between half to three-quarters of a typical doctors or specialists visit.
Insured persons have a standardized credit card style SIS-card which is needed in pharmacies and hospitals.
Bhutan
BhutanBhutan
Bhutan , officially the Kingdom of Bhutan, is a landlocked state in South Asia, located at the eastern end of the Himalayas and bordered to the south, east and west by the Republic of India and to the north by the People's Republic of China...
's health care system development accelerated in the early 1960s with the establishment of the Department of Public Health and the opening of new hospitals and dispensaries throughout the country. By the early 1990s, health care was provided through twenty-nine general hospitals (including five leprosy hospitals, three army hospitals, and one mobile hospital), forty-six dispensaries, sixty-seven basic health units, four indigenous-medicine dispensaries, and fifteen malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
eradication centers. The major hospitals were the National Referral Hospital
National Referral Hospital (Thimphu)
The National Referral Hospital is the main hospital in Bhutan, located in the capitol, Thimphu. Since it was established in 1972, the hospital has been supplying free basic medical treatment as well as advanced surgeries and emergency services to citizens from all over the country...
in Thimphu
Thimphu
Thimphu also spelt Thimpu, is the capital and largest city of Bhutan. It is situated in the western central part of Bhutan and the surrounding valley is one of Bhutan's dzongkhags, the Thimphu District. The city became the capital of Bhutan in 1961...
, and other hospitals in Geylegphug, and Tashigang. Hospital beds in 1988 totaled 932. There was a severe shortage of health-care personnel with official statistics reporting only 142 physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s and 678 paramedic
Paramedic
A paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...
s, about one health-care professional for every 2,000 people, or only one physician for almost 10,000 people. Training for health-care assistants, nurses' aide
Aide
Aide may refer to:* A person who assists another; an assistant. In military contexts; an officer who acts as assistant to a more senior one; an aide-de-camp.* Aide , a purported Basque deity....
s, midwives, and primary health-care workers was provided at the Royal Institute of Health Sciences
Royal Institute of Health Sciences (Bhutan)
The Royal Institute of Health Sciences is one of two main medical education centers in Bhutan, the other being the Institute of Traditional Medicine Services. The RIHS was established in Thimphu in 1974 as a member college of the Royal University of Bhutan, and is associated with the National...
, associated with Thimphu General Hospital, which was established in 1974. Graduates of the school were the core of the national public health system and helped staff the primary care basic health units throughout the country. Additional health-care workers were recruited from among volunteers in villages to supplement primary health care. The Institute of Traditional Medicine Services
Institute of Traditional Medicine Services (Bhutan)
The Institute of Traditional Medicine Services is based in Thimphu, the capital of Bhutan, located on a hilltop above the Traditional Arts Center and the National Library. The Institute supplies traditional medicines and medical services, trains doctors, and conducts research on traditional...
supports indigenous medical centers associated with the district hospitals.
Brazil
The Brazilian health system is composed of a large, public, government managed system, the SUS (Sistema Único de SaúdeSistema Único de Saúde
The Sistema Único de Saúde is Brazil's publicly-funded health care system. SUS was created after the Brazilian Constitution of 1988, which assured that health care is a "right of all and an obligation of the State" . Prior to that, only people who contributed with the social security were able to...
) , which serves the majority of the population, and a private sector, managed by health insurance funds and private entrepreneurs.
The public health system, SUS, was established in 1988 by the Brazilian Constitution, and sits on 3 basic principles of universality, comprehensiveness and equity. Universality states that all citizens must have access to health care services, without any form of discrimination, regarding skin color, income, social status, gender or any other variable.
Government standards state that citizen's health is the result of multiple variables, including employment, income, access to land, sanitation services, access and quality of health services, education, psychic, social and family conditions, and are entitled to full and complete health care, comprising prevention, treatment and rehabilitation. Equity states that health policies should be oriented towards the reduction of inequalities between population groups and individuals, being the most needed the ones for whom policies should be first directed.
SUS also has guidelines for its implementation, the most peculiar being popular participation, which defines that all policies are to be planned and supervised directly by the population, through local, city, state and national health councils and conferences. This is regarded as a very advanced form of direct democracy and has established the guidelines for many similar initiatives in sectors other than health all over Brazilian society.
The level of public spending is particularly high in relation to GDP for a country of Brazil’s income level and in comparison with its emerging-market peers. Government outlays on health care alone account for nearly 9% of GDP, the second largest item of spending following social protection. In health care, a number of conventional output indicators are not out of step with OECD averages. Following the decentralisation of service delivery in the early 1990s, increasing emphasis has appropriately been placed on enhancing preventive care. But, in a decentralised setting, cost-effectiveness depends a great deal on the ability of service deliverers to exploit economies of scale and scope. Experience with inter-municipal initiatives for procurement, as well as flexible arrangements for hospital administration and human-resource management, is by and large positive.
Private Health Insurance is widely available in Brazil and may be purchased on an individual-basis or obtained as a work benefit (major employers usually offer private health insurance benefits). Public health care is still accessible for those who choose to obtain private health insurance. As of March, 2007, more than 37 million Brazilians had some sort of private health insurance.
Bulgaria
BulgariaBulgaria
Bulgaria , officially the Republic of Bulgaria , is a parliamentary democracy within a unitary constitutional republic in Southeast Europe. The country borders Romania to the north, Serbia and Macedonia to the west, Greece and Turkey to the south, as well as the Black Sea to the east...
began overall reform of its antiquated health system, inherited from the communist era, only in 1999. In the 1990s, private medical practices expanded somewhat, but most Bulgarians relied on communist-era public clinic
Clinic
A clinic is a health care facility that is primarily devoted to the care of outpatients...
s while paying high prices for special care. During that period, national health indicators generally worsened as economic crises substantially decreased health funding. The subsequent health reform program has introduced mandatory employee health insurance through the National Health Insurance Fund (NHIF), which since 2000 has paid a gradually increasing portion of primary health-care costs. Employees and employers pay an increasing, mandatory percentage of salaries
Salary
A salary is a form of periodic payment from an employer to an employee, which may be specified in an employment contract. It is contrasted with piece wages, where each job, hour or other unit is paid separately, rather than on a periodic basis....
, with the goal of gradually reducing state support of health care. Private health insurance plays only a supplementary role. The system also has been decentralized by making municipalities responsible for their own health-care facilities, and by 2005 most primary care came from private physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s. Pharmaceutical distribution also was decentralized.
In the early 2000s, the hospital system was reduced substantially to limit reliance on hospitals for routine care. Anticipated membership in the European Union
European Union
The European Union is an economic and political union of 27 independent member states which are located primarily in Europe. The EU traces its origins from the European Coal and Steel Community and the European Economic Community , formed by six countries in 1958...
(2007) was a major motivation for this trend. Between 2002 and 2003, the number of hospital beds was reduced by 56 percent to 24,300. However, the pace of reduction slowed in the early 2000s; in 2004 some 258 hospitals were in operation, compared with the estimated optimal number of 140. Between 2002 and 2004, health-care expenditures in the national budget increased from 3.8 percent to 4.3 percent, with the NHIF accounting for more than 60 percent of annual expenditures.
In the 1990s, the quality of medical research and training decreased seriously because of low funding. In the early 2000s, the emphasis of medical and paramedic
Paramedic
A paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...
al training, which was conducted in five medical schools, was preparation of primary-care personnel to overcome shortages resulting from the communist system’s long-term emphasis on training specialists. Experts considered that Bulgaria had an adequate supply of doctor
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s but a shortage of other medical personnel. In 2000 Bulgaria had 3.4 doctors, 3.9 nurses, and 0.5 midwives per 1,000 population.
Canada
CanadaCanada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
has a federally sponsored, publicly funded Medicare
Medicare (Canada)
Medicare is the unofficial name for Canada's publicly funded universal health insurance system. The formal terminology for the insurance system is provided by the Canada Health Act and the health insurance legislation of the individual provinces and territories.Under the terms of the Canada Health...
system, with most services provided by the private sector. The country's prime minister and most premiers say they are committed to the Social Union Framework Agreement
Social Union Framework Agreement
The Social Union Framework Agreement, or SUFA, was an agreement made in Canada in 1999 between Prime Minister Jean Chrétien and the premiers of the provinces and territories of Canada, save Quebec Premier Lucien Bouchard...
that promotes "comprehensiveness, universality, portability, public administration and accessibility" in health care. In 1984, the Canada Health Act
Canada Health Act
The Canada Health Act is a piece of Canadian federal legislation, adopted in 1984, which specifies the conditions and criteria with which the provincial and territorial health insurance programs must conform in order to receive federal transfer payments under the Canada Health Transfer...
was passed, which prohibited extra billing by doctors on patients while at the same time billing the public insurance system. Each province may opt out, though none currently choose to. Some provinces still charge premiums to individuals and families. Many employers also offer additional health coverage as a benefit.
Canada's system is known as a single payer system, where basic services are provided by private doctors, (since 2002 they have been allowed to incorporate), with the entire fee paid for by the government at the same rate. Most family doctors receive a fee per visit. These rates are negotiated between the provincial governments and the province's medical associations, usually on an annual basis. A physician cannot charge a fee for a service that is higher than the negotiated rate — even to patients who are not covered by the publicly funded system — unless he or she opts out of billing the publicly funded system altogether. Pharmaceutical costs are set at a global median by government price controls. Other areas of health care, such as dentistry
Dentistry
Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...
and optometry
Optometry
Optometry is a health care profession concerned with eyes and related structures, as well as vision, visual systems, and vision information processing in humans. Optometrists, or Doctors of Optometry, are state licensed medical professionals trained to prescribe and fit lenses to improve vision,...
, are wholly private, although in some provinces emergency visits to optometrists are partly covered by medicare. In 2005, Canada spent 9.8% of GDP on health care, or US$3,463 per capita. Of that, approximately 70% was government expenditure.
In May 2011, the Health Council released a report entitled: "Progress Report 2011: Health Care Renewal in Canada", which provides a pan-Canadian look at five key commitments of the 2003 First Ministers' Accord on Health Care Renewal and the 2004 10-Year Plan to Strengthen Health Care. This report highlights the progress being achieved to date on wait times, pharmaceuticals management, electronic health records, teletriage, and health innovation.
Cape Verde
Medical facilities in Cape VerdeCape Verde
The Republic of Cape Verde is an island country, spanning an archipelago of 10 islands located in the central Atlantic Ocean, 570 kilometres off the coast of Western Africa...
are limited, and some medicines are in short supply or unavailable. There are hospitals in Praia
Praia
Praia , is the capital and largest city of Cape Verde, an island nation in the Atlantic Ocean west of Senegal. It lies on the southern coast of Santiago island in the Sotavento Islands group. It is the island's ferry port and is home to one of the nation’s four international airports...
and Mindelo
Mindelo
For the parish in Portugal, see Mindelo, PortugalMindelo , is a port city in the northern part of the island of São Vicente in Cape Verde. Mindelo is also the seat of the parish of Nossa Senhora da Luz, and this island's municipality...
, with smaller medical facilities in other places. The islands of Brava
Brava, Cape Verde
Brava is an island in Cape Verde. It is the smallest inhabited island, but at the same time the greenest, of Cape Verde, in the Sotavento group. First settled in the 1540s, its population grew after Mount Fogo on neighbouring Fogo erupted in 1675...
and Santo Antão no longer have functioning airports so air evacuation in the event of a medical emergency is nearly impossible from these two islands. Brava also has limited inter-island ferry service.
Chile
ChileChile
Chile ,officially the Republic of Chile , is a country in South America occupying a long, narrow coastal strip between the Andes mountains to the east and the Pacific Ocean to the west. It borders Peru to the north, Bolivia to the northeast, Argentina to the east, and the Drake Passage in the far...
has maintained a dual health care system in which its citizens can voluntarily opt for coverage by either the public National Health Insurance Fund or any of the country's private health insurance companies. 68% of the population is covered by the public fund and 18% by private companies. The remaining 14% is covered by other not-for-profit agencies or has no specific coverage. The system's duality has led to increasing inequalities prompting the Chilean government to introduce major reforms in health care provision. Chile's health care system is funded by a universal income tax deduction equal to 7% of every worker's wage. Many private health insurance companies encourage people to pay a variable extra on top of the 7% premium to upgrade their basic health plans. Because of this arrangement, the public and private health subsystems have existed almost completely separate from each other rather than coordinating to achieve common health objectives.
Costa Rica
Costa RicaCosta Rica
Costa Rica , officially the Republic of Costa Rica is a multilingual, multiethnic and multicultural country in Central America, bordered by Nicaragua to the north, Panama to the southeast, the Pacific Ocean to the west and the Caribbean Sea to the east....
provides universal health care to its citizens and permanent residents.
Cuba
Health care in CubaCuba
The Republic of Cuba is an island nation in the Caribbean. The nation of Cuba consists of the main island of Cuba, the Isla de la Juventud, and several archipelagos. Havana is the largest city in Cuba and the country's capital. Santiago de Cuba is the second largest city...
consists of a government-coordinated system that guarantees universal coverage and consumes a lower proportion of the nation's GDP (7.3%) than some highly privatised systems (e.g. USA: 16%) (OECD 2008). The system does charge fees in treating elective treatment for patients from abroad, but tourists who fall ill are treated free in Cuban hospitals. Cuba attracts patients mostly from Latin America
Latin America
Latin America is a region of the Americas where Romance languages – particularly Spanish and Portuguese, and variably French – are primarily spoken. Latin America has an area of approximately 21,069,500 km² , almost 3.9% of the Earth's surface or 14.1% of its land surface area...
and Europe
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
by offering care of comparable quality to a developed nation but at much lower prices. Cuba's own health indicators are the best in Latin America and surpass those of the US in some respects (infant mortality rates, underweight babies, HIV infection, immunisation rates, doctor per population rates). (UNDP 2006: Tables 6,7,9,10) In 2005, Cuba spent 7.6% of GDP on health care, or US$310 per capita. Of that, approximately 91% was government expenditure.
Denmark
Denmark's health care system has retained the same basic structure since the early 1970s. The administration of hospitals and personnel is dealt with by the Ministry of the Interior, while primary care facilities, health insurance, and community care are the responsibility of the Ministry of Social Affairs. Anyone can go to a physician for no fee and the public health system entitles each Dane to his/her own doctor. Expert medical/surgical aid is available, with a qualified nursing staff. Costs are borne by public authorities, but high taxes contribute to these costs. As of 1999, there were an estimated 3.4 physicians and 4.5 hospital beds per 1,000 people. The number of hospital beds, like that in other EU countries, has undergone a major decline since 1980, from around 40,000 to about 23,000 in 1998/99. Deinstitutionalization of psychiatric patients has contributed significantly to this trend. The ratio of doctors to population, by contrast, has increased during this period.The total fertility rate in 2000 was 1.7, while the maternal mortality rate was 10 per 100,000 live births as of 1998. Studies show that between 1980 and 1993, 63% of married women (ages 15 to 49) used contraception. As of 2002 cardiovascular diseases and cancer were the leading causes of death. Denmark's cancer rates were the highest in the European Union. In 1999, there were only 12 reported cases of tuberculosis per 100,000 people. As of 1999, the number of people living with HIV/AIDS was estimated at 4,300 and deaths from AIDS that year were estimated at less than 100. HIV prevalence was 0.17 per 100 adults.
Danish citizens may choose between two systems of primary health care: medical care paid for by the government provided by a doctor whom the individual chooses for a year and by those specialists to whom the doctor refers the patient; or complete freedom of choice of any physician or specialist at any time, with state reimbursement of about two-thirds of the cost for medical bills paid directly by the patient. Most Danes opt for the former. All patients receive subsidies on pharmaceuticals and vital drugs; everyone must pay a share of dental bills. As of 1999, total health care expenditure was estimated at 8.4% of GDP.
Responsibility for the public hospital service rests with county authorities. Counties form public hospital regions, each of which is allotted one or two larger hospitals with specialists and two to four smaller hospitals where medical treatment is practically totally paid for by the government. State-appointed medical health officers, responsible to the National Board of Health, are employed to advise local governments on health matters. Public health authorities have waged large-scale campaigns against tuberculosis, venereal diseases, diphtheria, and poliomyelitis. The government-paid guidance and assistance given to mothers of newborn children by public health nurses have resulted in a low infant mortality rate of 4 per 1,000 live births (2000). Medical treatment is government-paid up to school age, when government-paid school medical inspections begin. As of 1999, children up to one year of age were vaccinated against diphtheria, pertussis, and tetanus (99%) and measles (92%). In 2000, life expectancy at birth was 76 years for males and females. The overall death rate was 11 per 1,000 people in 1999.
Read more: Health - Denmark - system http://www.nationsencyclopedia.com/Europe/Denmark-HEALTH.html#ixzz0kk32t7BP
Eritrea
Health in EritreaHealth in Eritrea
Health in Eritrea is generally poor as it remains one of the poorest countries in the world. Over two-thirds of the population lives below the national poverty line and the vast majority in rural areas, about one-third of the population lives in extreme poverty and more than half survives on less...
is generally poor as it remains one of the poorest countries in the world. About one-third of the population lives in extreme poverty
Poverty
Poverty is the lack of a certain amount of material possessions or money. Absolute poverty or destitution is inability to afford basic human needs, which commonly includes clean and fresh water, nutrition, health care, education, clothing and shelter. About 1.7 billion people are estimated to live...
, and more than half survives on less than US$1 per day. Health care and welfare resources generally are believed to be poor, although reliable information about conditions is often difficult to obtain. In 2001, the most recent year for which figures are available, the Eritrean government spent 5.7 percent of gross domestic product
Gross domestic product
Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....
on national health accounts. The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(WHO) estimated that in 2004 there were only three physicians per 100,000 people in Eritrea
Eritrea
Eritrea , officially the State of Eritrea, is a country in the Horn of Africa. Eritrea derives it's name from the Greek word Erethria, meaning 'red land'. The capital is Asmara. It is bordered by Sudan in the west, Ethiopia in the south, and Djibouti in the southeast...
. The two-year war with Ethiopia
Ethiopia
Ethiopia , officially known as the Federal Democratic Republic of Ethiopia, is a country located in the Horn of Africa. It is the second-most populous nation in Africa, with over 82 million inhabitants, and the tenth-largest by area, occupying 1,100,000 km2...
, coming on the heels of a 30-year struggle for independence, negatively affected the health sector and the general welfare. The rate of prevalence of human immunodeficiency virus/acquired immune deficiency syndrome (HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
/AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
), although low by sub-Saharan Africa
Sub-Saharan Africa
Sub-Saharan Africa as a geographical term refers to the area of the African continent which lies south of the Sahara. A political definition of Sub-Saharan Africa, instead, covers all African countries which are fully or partially located south of the Sahara...
n standards, was high enough at 2.7 percent in 2003 to be considered a generalized epidemic. In the decade since 1995, however, impressive results have been achieved in lowering maternal and child mortality
Child mortality
Child mortality, also known as under-5 mortality, refers to the death of infants and children under the age of five. In 2010, 7.6 million children under five died , down from 8.1 million in 2009, 8.8 million in 2008, and 12.4 million in 1990. About half of child deaths occur in Africa....
rates and in immunizing children against childhood diseases. In 2003 average life expectancy
Life expectancy
Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...
was slightly less than 53 years, according to the WHO.
Estonia
Healthcare in Estonia is supervised by the Ministry of Social Affairs and funded by general taxation through the National Health Service.Ethiopia
Throughout the 1990s, the government, as part of its reconstruction program, devoted ever-increasing amounts of funding to the social and health sectors, which brought corresponding improvements in school enrollments, adult literacyLiteracy
Literacy has traditionally been described as the ability to read for knowledge, write coherently and think critically about printed material.Literacy represents the lifelong, intellectual process of gaining meaning from print...
, and infant mortality rates. These expenditures stagnated or declined during the 1998–2000 war with Eritrea
Eritrean-Ethiopian War
The Eritrean–Ethiopian War took place from May 1998 to June 2000 between Ethiopia and Eritrea, forming one of the conflicts in the Horn of Africa...
, but in the years since, outlays for health have grown steadily. In 2000–2001, the budget allocation for the health sector was approximately US$144 million; health expenditures per capita were estimated at US$4.50, compared with US$10 on average in sub-Saharan Africa. In 2000 the country counted one hospital bed per 4,900 population and more than 27,000 people per primary health care facility. The physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
to population ratio was 1:48,000, the nurse to population ratio, 1:12,000. Overall, there were 20 trained health providers per 100,000 inhabitants. These ratios have since shown some improvement. Health care is disproportionately available in urban centers; in rural areas where the vast majority of the population resides, access to health care varies from limited to nonexistent. As of the end of 2003, the United Nations
United Nations
The United Nations is an international organization whose stated aims are facilitating cooperation in international law, international security, economic development, social progress, human rights, and achievement of world peace...
(UN) reported that 4.4 percent of adults were infected with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS); other estimates of the rate of infection ranged from a low of 7 percent to a high of 18 percent. Whatever the actual rate, the prevalence of HIV/AIDS
HIV/AIDS in Ethiopia
Ethiopia has a large and very vulnerable population, with an estimated 15 percent of the population living below the poverty line. HIV/AIDS is one of the key challenges for the overall development of Ethiopia, as it has led to a seven-year decrease in life expectancy and a greatly reduced...
has contributed to falling life expectancy since the early 1990s. According to the Ministry of Health, one-third of current young adult deaths are AIDS-related. Malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
is widespread, especially among children, as is food insecurity. Because of growing population pressure on agricultural and pastoral land, soil degradation, and severe droughts that have occurred each decade since the 1970s, per capita food production is declining. According to the UN and the World Bank
World Bank
The World Bank is an international financial institution that provides loans to developing countries for capital programmes.The World Bank's official goal is the reduction of poverty...
, Ethiopia at present suffers from a structural food deficit such that even in the most productive years, at least 5 million Ethiopians require food relief.
In 2002 the government embarked on a poverty reduction program that called for outlays in education, health, sanitation, and water. A polio vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
campaign for 14 million children has been carried out, and a program to resettle
Resettlement and villagization in Ethiopia
Resettlement and villagization in Ethiopia has been an issue since the late nineteenth century, due to the overcrowded population of the Ethiopian highlands...
some 2 million subsistence farmers is underway. In November 2004, the government launched a five-year program to expand primary health care. In January 2005, it began distributing antiretroviral drugs, hoping to reach up to 30,000 HIV-infected adults.
Finland
In FinlandFinland
Finland , officially the Republic of Finland, is a Nordic country situated in the Fennoscandian region of Northern Europe. It is bordered by Sweden in the west, Norway in the north and Russia in the east, while Estonia lies to its south across the Gulf of Finland.Around 5.4 million people reside...
, public medical services at clinics and hospitals are run by the municipalities (local government) and are funded 78% by taxation, 20% by patients through access charges, and by others 2%. Patient access charges are subject to annual caps. For example GP visits are (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, all treatment and medications thereafter are paid for by the government. Taxation funding is partly local and partly nationally based. Patients can claim re-imbursement of part of their prescription costs from KELA. Finland also has a much smaller private medical sector which 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. Private sector patients can claim a contribution from KELA towards their private medical costs (including dentistry
Dentistry
Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...
) if they choose to be treated in the more expensive private sector, or they can join private insurance funds. However, private sector health care is mainly in the primary care sector. There are virtually no private hospitals, the main hospitals being either municipally owned (funded from local taxes) or run by the teaching universities (funded jointly by the municipalities and the national government). In 2005, Finland spent 7.5% of GDP on health care, or US$2,824 per capita. Of that, approximately 78% was government expenditure.
France
In its 2000 assessment of world health care systemsWHO's ranking of health care systems
The World Health Organization ranked the healthcare systems of its 191 member states in its World Health Report 2000. It provided a framework and measurement approach to examine and compare aspects of health systems around the world...
, the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
found that France provided the "best overall health care" in the world. In 2005, France spent 11.2% of GDP on health care, or US$3,926 per capita. Of that, approximately 80% was government expenditure.
In France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
, most doctors remain in private practice; there are both private
Private sector
In economics, the private sector is that part of the economy, sometimes referred to as the citizen sector, which is run by private individuals or groups, usually as a means of enterprise for profit, and is not controlled by the state...
and public
Public
In public relations and communication science, publics are groups of individuals, and the public is the totality of such groupings. This is a different concept to the sociological concept of the Öffentlichkeit or public sphere. The concept of a public has also been defined in political science,...
hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s. Social Security consists of several public organizations, distinct from the state government, with separate budgets that refunds patients for care in both private and public facilities. It generally refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Supplemental coverage may be bought from private insurers, most of them nonprofit, mutual insurers, to the point that the word "mutuelle" (mutual) has come to be a synonym of supplemental private insurer in common language. Until recently, social security coverage was restricted to those who contributed to social security (generally, workers, unemployed or retirees), excluding some few poor segments of the population; the government of Lionel Jospin
Lionel Jospin
Lionel Jospin is a French politician, who served as Prime Minister of France from 1997 to 2002.Jospin was the Socialist Party candidate for President of France in the elections of 1995 and 2002. He was narrowly defeated in the final runoff election by Jacques Chirac in 1995...
put into place the "universal health coverage" allowing the entire French population to benefit from Health care. In some systems, patients can also take private health insurance, but choose to receive care at public hospitals, if allowed by the private insurer. For serious illness, regardless of the insurance regime, the national health system will assume the cost of long-term remedial treatment.
Germany
GermanyGermany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
has a universal multi-payer system with two main types of health insurance: "Law-enforced health insurance" (Gesetzliche Krankenversicherung) known as sickness funds and "Private" (Private Krankenversicherung). Compulsory insurance applies to those below a set income level and is provided through private non-profit "sickness funds" at common rates for all members, and is paid for with joint employer-employee contributions. Provider compensation rates are negotiated in complex corporatist
Corporatism
Corporatism, also known as corporativism, is a system of economic, political, or social organization that involves association of the people of society into corporate groups, such as agricultural, business, ethnic, labor, military, patronage, or scientific affiliations, on the basis of common...
social bargaining among specified autonomously organized interest groups (e.g. physicians' associations) at the level of federal states
States of Germany
Germany is made up of sixteen which are partly sovereign constituent states of the Federal Republic of Germany. Land literally translates as "country", and constitutionally speaking, they are constituent countries...
(Länder). The sickness funds are mandated to provide a wide range of coverages and cannot refuse membership or otherwise discriminate on an actuarial basis. Small numbers of persons are covered by tax-funded government employee insurance or social welfare insurance. Persons with incomes above the prescribed compulsory insurance level may opt into the sickness fund system, which a majority do, or purchase private insurance. Private supplementary insurance to the sickness funds of various sorts is available. In 2005, Germany spent 10.7% of GDP on health care, or US$3,628 per capita. Of that, approximately 77% was government expenditure.
Ghana
In GhanaGhana
Ghana , officially the Republic of Ghana, is a country located in West Africa. It is bordered by Côte d'Ivoire to the west, Burkina Faso to the north, Togo to the east, and the Gulf of Guinea to the south...
, most health care is provided by the government, but hospitals and clinics run by religious groups also play an important role. Some for-profit clinics exist, but they provide less than 2% of health services. Health care is very variable through the country. The major urban centres are well served, but rural areas often have no modern health care. Patients in these areas either rely on traditional medicine or travel great distances for care. In 2005, Ghana spent 6.2% of GDP on health care, or US$30 per capita. Of that, approximately 34% was government expenditure.
Greece
The Greek healthcare systemHealth care in Greece
250px|right|thumb|The logo of the Ministry for Health and Social Solidarity.Health care in Greece is provided by the state through a universal health care system funded mostly through national health insurance, although private health care is also an option. According to the 2011 budget, the Greek...
is universal and is ranked as one of the best in the world. In a 2000 World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
report it was ranked 14th in the overall assessment and 11th at quality of service, surpassing countries such as the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
] (18th) and Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
(25th). In 2010 there were 131 hospitals with 35,000 beds in the country, but on 1 July 2011 the Ministry for Health and Social Solidarity announced its proposal to shorten the number to 83 hospitals with 33,000 beds. Greece's healthcare expenditures as a percentage of GDP were 9.6% in 2007 according to a 2011 OECD report, just above the OECD average of 9.5%. The country has the largest number of doctors-to-population ratio of any OECD country.
Life expectancy
Life expectancy
Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...
in Greece is 80.3 years, above the OECD average of 79.5. and among the highest in the world. The same OECD report showed that Greece had the largest percentage of adult daily smokers of any of the 34 OECD members. The country's obesity rate is 18.1%, which is above the OECD average of 15.1% but considerably below the American rate of 27.7%. In 2008 Greece had the highest rate of perceived good health in the OECD, at 98.5%. Infant mortality is one of the lowest in the developed world
Developed country
A developed country is a country that has a high level of development according to some criteria. Which criteria, and which countries are classified as being developed, is a contentious issue...
with a rate of 3.1 deaths/1000 live births.
Guinea
- See also: Health care in Guinea
Guinea
Guinea
Guinea , officially the Republic of Guinea , is a country in West Africa. Formerly known as French Guinea , it is today sometimes called Guinea-Conakry to distinguish it from its neighbour Guinea-Bissau. Guinea is divided into eight administrative regions and subdivided into thirty-three prefectures...
has been reorganizing its health system since the Bamako Initiative
Bamako Initiative
The Bamako Initiative was a formal statement adopted by African health ministers in 1987 in Bamako, Mali, to implement strategies designed to increase the availability of essential drugs and other healthcare services for Sub-Saharan Africans....
of 1987 formally promoted community-based methods of increasing accessibility of primary health care
Primary health care
Primary health care, often abbreviated as “PHC”, has been defined as "essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost...
to the population, including community ownership and local budgeting, resulting in more efficient and equitable provision of drugs and other essential health care resources.
In June 2011, the Guinean government announced the establishment of an air ticket solidarity levy on all flights taking off from national soil, with funds going to UNITAID
Unitaid
UNITAID is an international facility for the purchase of drugs against HIV/AIDS, Malaria and Tuberculosis. It was founded in September 2006 on the initiative of Brazil and France, and is to a great part financed by so called innovative development financing mechanisms, namely a solidarity levy on...
to support expanded access to treatment for HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
/AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
, tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
and malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
. Guinea is among the growing number of countries and development partners using market-based transactions taxes and other innovative financing
Innovative financing
Innovative financing refers to a range of non-traditional mechanisms to raise additional funds for development aid through "innovative" projects such as micro-contributions, taxes, public-private partnerships and market-based financial transactions....
mechanisms to expand financing options for health care in resource-limited settings.
India
In the greater IndiaIndia
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
, the hospitals are run by government, charitable trusts and by private organizations. The government hospitals in rural areas are called the (PHC
PHC
PHC may refer to:In court*Peshawar High Court of Khyber-Pakhtunkhwa, PakistanIn education*PhC, the acronym for Candidate of Philosophy degree*PhC, the acronym for a degree in Pharmaceutical Chemistry*Patrick Henry College...
)s primary health centre. Major hospitals are located in district head quarters or major cities. Apart from the modern system of medicine, traditional and indigenous medicinal systems like Ayurvedic and Unani
Unani
Unani-tibb or Unani Medicine also spelled Yunani Medicine means "Greek Medicine", and is a form of traditional medicine widely practiced in South Asia...
systems are in practice throughout the country. The Modern System of Medicine is regulated by the Medical Council of India
Medical Council of India
The Medical Council of India was the statutory body for maintenance of uniform and high standards of medical education in India. The Council grants recognition of medical qualifications, gives accreditation to medical colleges, grants registration to medical practitioners, and monitors medical...
, whereas the Alternative systems recognised by Government of India are regulated by the Department of AYUSH
AYUSH
The Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy is a part of the Ministry of Health & Family Welfare of the Government of India....
(an acronym for Ayurveda
Ayurveda
Ayurveda or ayurvedic medicine is a system of traditional medicine native to India and a form of alternative medicine. In Sanskrit, words , meaning "longevity", and , meaning "knowledge" or "science". The earliest literature on Indian medical practice appeared during the Vedic period in India,...
, Yoga
Yoga
Yoga is a physical, mental, and spiritual discipline, originating in ancient India. The goal of yoga, or of the person practicing yoga, is the attainment of a state of perfect spiritual insight and tranquility while meditating on Supersoul...
, Unani
Unani
Unani-tibb or Unani Medicine also spelled Yunani Medicine means "Greek Medicine", and is a form of traditional medicine widely practiced in South Asia...
, Siddha
Siddha
A Siddha सिद्ध in Sanskrit means "one who is accomplished" and refers to perfected masters who, according to Hindu belief, have transcended the ahamkara , have subdued their minds to be subservient to their Awareness, and have transformed their bodies into a different kind of body dominated by...
& Homeopathy
Homeopathy
Homeopathy is a form of alternative medicine in which practitioners claim to treat patients using highly diluted preparations that are believed to cause healthy people to exhibit symptoms that are similar to those exhibited by the patient...
) under the Ministry of Health, Government of India. PHCs are non-existent in most places, due to poor pay and scarcity of resources. Patients generally prefer private health clinics. These days some of the major corporate hospitals are attracting patients from neighboring countries such as Pakistan
Pakistan
Pakistan , officially the Islamic Republic of Pakistan is a sovereign state in South Asia. It has a coastline along the Arabian Sea and the Gulf of Oman in the south and is bordered by Afghanistan and Iran in the west, India in the east and China in the far northeast. In the north, Tajikistan...
, countries in the Middle East
Middle East
The Middle East is a region that encompasses Western Asia and Northern Africa. It is often used as a synonym for Near East, in opposition to Far East...
and some Europe
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
an countries by providing quality treatment at low cost. In 2005, India spent 5% of GDP on health care, or US$36 per capita. Of that, approximately 19% was government expenditure.,.In Addition Acupressure,Acupuncture,Yoga,Naturopathy,Physiotherapy and Electrohomeopathy are the other systems of treatment used in India
Indonesia
IndonesiaIndonesia
Indonesia , officially the Republic of Indonesia , is a country in Southeast Asia and Oceania. Indonesia is an archipelago comprising approximately 13,000 islands. It has 33 provinces with over 238 million people, and is the world's fourth most populous country. Indonesia is a republic, with an...
had a three-tiered system of community health
Community health
Community health, a field of public health, is a discipline that concerns itself with the study and betterment of the health characteristics of biological communities. While the term community can be broadly defined, community health tends to focus on geographic areas rather than people with shared...
centers in the late 1990s, with 0.66 hospital beds per 1,000 population, the lowest rate among members of the Association of Southeast Asian Nations
Association of Southeast Asian Nations
The Association of Southeast Asian Nations, commonly abbreviated ASEAN rarely ), is a geo-political and economic organization of ten countries located in Southeast Asia, which was formed on 8 August 1967 by Indonesia, Malaysia, the Philippines, Singapore and Thailand. Since then, membership has...
(ASEAN). In the mid-1990s, according to the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(WHO), there were 16 physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s per 100,000 population in Indonesia, 50 nurses per 100,000, and 26 midwives per 100,000. Both traditional and modern health practices are employed. Government health expenditures are about 3.7 percent of the gross domestic product
Gross domestic product
Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....
(GDP). There is about a 75:25 percent ratio of public to private health-care expenditures.
Ireland
All persons resident in the Republic of IrelandRepublic of Ireland
Ireland , described as the Republic of Ireland , is a sovereign state in Europe occupying approximately five-sixths of the island of the same name. Its capital is Dublin. Ireland, which had a population of 4.58 million in 2011, is a constitutional republic governed as a parliamentary democracy,...
are entitled to health care through the public health care system, which is managed by the Health Service Executive
Health Service Executive
The Health Service Executive is responsible for the provision of healthcare providing health and personal social services for everyone living in Ireland, with public funds. The Executive was established by the Health Act, 2004 and came into official operation on January 1, 2005...
and funded by general taxation. A person may be required to pay a subsidised fee for certain health care received; this depends on income, age, illness or disability. All maternity services are however paid for by the government, as well as health care of infants under 6 months of age. Emergency care is provided at a cost of €120 for a visit to hospitals Accident and Emergency departments.
Israel
In IsraelIsrael
The State of Israel is a parliamentary republic located in the Middle East, along the eastern shore of the Mediterranean Sea...
, the publicly funded medical system is universal and compulsory. In 2005, Israel spent 7.8% of GDP on health care, or US$1,533 per capita. Of that, approximately 66% was government expenditure.
Italy
According to WHO in 2000WHO's ranking of health care systems
The World Health Organization ranked the healthcare systems of its 191 member states in its World Health Report 2000. It provided a framework and measurement approach to examine and compare aspects of health systems around the world...
, Italy had the world's "second overall best" healthcare system in the world, coming after France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
, and surpassing Spain
Spain
Spain , officially the Kingdom of Spain languages]] under the European Charter for Regional or Minority Languages. In each of these, Spain's official name is as follows:;;;;;;), is a country and member state of the European Union located in southwestern Europe on the Iberian Peninsula...
, Oman
Oman
Oman , officially called the Sultanate of Oman , is an Arab state in southwest Asia on the southeast coast of the Arabian Peninsula. It is bordered by the United Arab Emirates to the northwest, Saudi Arabia to the west, and Yemen to the southwest. The coast is formed by the Arabian Sea on the...
and Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
.
In 1978 Italy
Italy
Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...
adopted a tax-funded universal health care
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.-History:...
system called "National Health Service" (in Italian
Italian language
Italian is a Romance language spoken mainly in Europe: Italy, Switzerland, San Marino, Vatican City, by minorities in Malta, Monaco, Croatia, Slovenia, France, Libya, Eritrea, and Somalia, and by immigrant communities in the Americas and Australia...
: Servizio Sanitario Nazionale), which was closely modeled on the British system. The SSN covers general practice (distinct between adult and pediatric practice), outpatient and inpatient treatments, and the cost of most (but not all) drugs and sanitary ware.
The government sets LEA (fundamental levels of care, Livelli essenziali di assistenza in Italian) which cover all necessary treatments, which the state must guarantee to all, paid for by the government, or for a "ticket", a share of the costs (but various categories are exempted).
The public system has also the duty of prevention at place of work and in the general environment.
A private sector also exists, with a minority role in medicine but a principal role in dental health, as most people prefer private dental services.
In Italy the public system has the unique feature of paying general practitioners a fee per capita
Per capita
Per capita is a Latin prepositional phrase: per and capita . The phrase thus means "by heads" or "for each head", i.e. per individual or per person...
per year, a salary system, that does not reward repeat visits, testing, and referrals.
While there is a paucity of nurses, Italy has one of the highest doctor per capita ratios at 3.9 doctor
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s per 1,000 patients.
In 2005, Italy spent 8.9% of GDP on health care, or US$2,714 per capita. Of that, approximately 76% was government expenditure.
Japan
In JapanJapan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
, services are provided either through regional/national public hospitals or through private hospitals/clinics, and patients have universal access to any facility, though hospitals tend to charge higher for those without a referral. Public health insurance covers most citizens/residents and pays 70% or more cost for each care and each prescribed drug. Patients are responsible for the remainder (upper limits apply). The monthly insurance premium is 0-50,000 JPY per household (scaled to annual income). Supplementary private health insurance is available only to cover the co-payments or non-covered costs, and usually makes a fixed payment per days in hospital or per surgery performed, rather than per actual expenditure. In 2005, Japan spent 8.2% of GDP on health care, or US$2,908 per capita. Of that, approximately 83% was government expenditure.
Jordan
In comparison to most of its neighbors, JordanJordan
Jordan , officially the Hashemite Kingdom of Jordan , Al-Mamlaka al-Urduniyya al-Hashemiyya) is a kingdom on the East Bank of the River Jordan. The country borders Saudi Arabia to the east and south-east, Iraq to the north-east, Syria to the north and the West Bank and Israel to the west, sharing...
has quite an advanced health care
Health care
Health care 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...
system, although services remain highly concentrated in Amman
Amman
Amman is the capital of Jordan. It is the country's political, cultural and commercial centre and one of the oldest continuously inhabited cities in the world. The Greater Amman area has a population of 2,842,629 as of 2010. The population of Amman is expected to jump from 2.8 million to almost...
. Government figures have put total health spending in 2002 at some 7.5 percent of Gross domestic product
Gross domestic product
Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....
(GDP), while international health organizations place the figure even higher, at approximately 9.3 percent of GDP. The country’s health care system is divided between public and private institutions. In the public sector, the Ministry of Health operates 1,245 primary health-care centers and 27 hospitals, accounting for 37 percent of all hospital beds in the country; the military’s Royal Medical Services runs 11 hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s, providing 24 percent of all beds; and the Jordan University Hospital accounts for 3 percent of total beds in the country. The private sector provides 36 percent of all hospital beds, distributed among 56 hospitals. In 1 June 2007, Jordan Hospital (as the biggest private hospital) was the first general specialty hospital who gets the international accreditation (JCI).Treatment cost in Jordan hospitals is less than in other countries.
Kazakhstan
In principle, health care is paid for by the government. However, bribes often are necessary to obtain needed care. The quality of health care, which remained entirely under state control in 2006, has declined in the post-Soviet era because of insufficient funding and the loss of technical experts through emigration. Between 1989 and 2001, the ratio of doctorsPhysician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
per 10,000 inhabitants fell by 15 percent, to 34.6, and the ratio of hospital beds per 10,000 inhabitants fell by 46 percent, to 74. By 2005 those indicators had recovered somewhat, to 55 and 77, respectively. Since 1991, health care has consistently lacked adequate government funding; in 2005 only 2.5 percent of gross domestic product
Gross domestic product
Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....
went for that purpose. A government health reform program aims to increase that figure to 4 percent in 2010. A compulsory health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
system has been in the planning stages for several years. Wages for health workers are extremely low, and equipment is in critically short supply. The main foreign source of medical equipment is Japan. Because of cost, the emphasis of treatment increasingly is on outpatient care instead of the hospital care preferred under the Soviet system. The health system is in crisis in rural areas such as the Aral Sea
Aral Sea
The Aral Sea was a lake that lay between Kazakhstan in the north and Karakalpakstan, an autonomous region of Uzbekistan, in the south...
region, where health is most affected by pollution
Pollution
Pollution is the introduction of contaminants into a natural environment that causes instability, disorder, harm or discomfort to the ecosystem i.e. physical systems or living organisms. Pollution can take the form of chemical substances or energy, such as noise, heat or light...
.
Mali
Health in MaliMali
Mali , officially the Republic of Mali , is a landlocked country in Western Africa. Mali borders Algeria on the north, Niger on the east, Burkina Faso and the Côte d'Ivoire on the south, Guinea on the south-west, and Senegal and Mauritania on the west. Its size is just over 1,240,000 km² with...
, one of the world’s poorest nations, is greatly affected by poverty
Poverty
Poverty is the lack of a certain amount of material possessions or money. Absolute poverty or destitution is inability to afford basic human needs, which commonly includes clean and fresh water, nutrition, health care, education, clothing and shelter. About 1.7 billion people are estimated to live...
, malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
, and inadequate hygiene
Hygiene
Hygiene refers to the set of practices perceived by a community to be associated with the preservation of health and healthy living. While in modern medical sciences there is a set of standards of hygiene recommended for different situations, what is considered hygienic or not can vary between...
and sanitation
Sanitation
Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of wastes. Hazards can be either physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems are human and animal feces, solid wastes, domestic...
. Mali's health and development indicators rank among the worst in the world. In 2000 only 62–65 percent of the population was estimated to have access to safe drinking water and only 69 percent to sanitation services of some kind; only 8 percent was estimated to have access to modern sanitation facilities. Only 20 percent of the nation’s villages and livestock watering holes had modern water facilities.
Mali is dependent on international development organizations and foreign missionary groups for much of its health care. In 2001 general government expenditures on health constituted 6.8 percent of total general government expenditures and 4.3 percent of gross domestic product
Gross domestic product
Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....
(GDP), totaling only about US$4 per capita at an average exchange rate. Medical facilities in Mali are very limited, especially outside of Bamako
Bamako
Bamako is the capital of Mali and its largest city with a population of 1.8 million . Currently, it is estimated to be the fastest growing city in Africa and sixth fastest in the world...
, and medicines are in short supply. There were only 5 physicians per 100,000 inhabitants in the 1990s and 24 hospital beds per 100,000 in 1998. In 1999 only 36 percent of Malians were estimated to have access to health services within a five-kilometer radius.
Malaysia
Health care in Malaysia is divided into private and public sectors. Doctors are required to undergo a 2 year internship and perform 3 years of service with public hospitals throughout the nation, ensuring adequate coverage of medical needs for the general population. Foreign doctors are encouraged to apply for employment in Malaysia, especially if they are qualified to a higher level.Malaysian society places importance on the expansion and development of health care, putting 5% of the government social sector development budget into public health care
Publicly-funded health care
Publicly funded health care is a form of health care financing designed to meet the cost of all or most health care needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population...
— an increase of more than 47% over the previous figure. This has meant an overall increase of more than RM 2 billion. With a rising and ageing population, the Government wishes to improve in many areas including the refurbishment of existing hospitals, building and equipping new hospitals, expansion of the number of polyclinics, and improvements in training and expansion of telehealth
Telehealth
Telehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth could be as simple as two health professionals discussing a case over the telephone or as sophisticated as doing robotic surgery between facilities at different ends of the...
. Over the last couple of years they have increased their efforts to overhaul the systems and attract more foreign investment.
There is still a shortage in the medical workforce, especially of highly trained specialists. As a result certain medical care and treatment is available only in large cities. Recent efforts to bring many facilities to other towns have been hampered by lack of expertise to run the available equipment made ready by investments.
The majority of private hospital
Private hospital
A private hospital is a hospital owned by a profit company or a non-profit organisation and privately funded through payment for medical services by patients themselves, by insurers, or by foreign embassies. This practice is very common in the United States and Australia...
facilities are in urban areas and, unlike many of the public hospitals, are equipped with the latest diagnostic and imaging facilities.
Mexico
Public
In public relations and communication science, publics are groups of individuals, and the public is the totality of such groupings. This is a different concept to the sociological concept of the Öffentlichkeit or public sphere. The concept of a public has also been defined in political science,...
institutions or private entities. Health care delivered through private health care organizations operates entirely on the free-market system (e.g. it is available to those who can afford it). Public health care delivery, on the other hand, is accomplished via an elaborate provisioning and delivery system put in place by the Mexican Federal Government and the Mexican Social Security Institute
Mexican Social Security Institute
The Mexican Social Security Institute is a governmental organization that attends to public health, pensions and social security in Mexico operating under Secretaría de Salud .-History:...
(IMSS).
Advances in medicine and increasing health knowledge have increased the life expectancy in Mexico
Mexico
The United Mexican States , commonly known as Mexico , is a federal constitutional republic in North America. It is bordered on the north by the United States; on the south and west by the Pacific Ocean; on the southeast by Guatemala, Belize, and the Caribbean Sea; and on the east by the Gulf of...
by an average of 25 years in the last years of the XX century. Of the 6.6% GDP of government revenue spent on health, this provides only health insurance to 40% of the population who are privately employed. The health care system has three components: the social security institute, governmental services for the un-insured (Seguro Popular), and the private sector that is financed almost completely from out of pocket money. The IMSS
Mexican Social Security Institute
The Mexican Social Security Institute is a governmental organization that attends to public health, pensions and social security in Mexico operating under Secretaría de Salud .-History:...
, the largest social institution in Latin America, is the governmental institution responsible of executing the Federal Government's health policy. The number of public hospitals in Mexico has increased 41% in ten years from 1985 to 1995.
According to the site www.internationalliving.com, health care in Mexico is described as very good to excellent while being highly affordable, with every medium to large city in Mexico having at least one first-rate hospital. In fact, some California insurers sell health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
policies that require members to go to Mexico for health care where costs are 40% lower. Some of Mexico's top-rate hospitals are internationally accredited. Americans, particularly those living near the Mexican border, now routinely cross the border into Mexico for medical care. Popular specialties include dentistry
Dentistry
Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...
and plastic surgery
Plastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...
. Mexican dentists often charge 20 to 25 percent of US prices, while other procedures typically cost a third what they would cost in the US.
Morocco
According to the United States government, MoroccoMorocco
Morocco , officially the Kingdom of Morocco , is a country located in North Africa. It has a population of more than 32 million and an area of 710,850 km², and also primarily administers the disputed region of the Western Sahara...
has inadequate numbers of physicians (0.5 per 1,000 people) and hospital beds (1.0 per 1,000 people) and poor access to water
Water
Water is a chemical substance with the chemical formula H2O. A water molecule contains one oxygen and two hydrogen atoms connected by covalent bonds. Water is a liquid at ambient conditions, but it often co-exists on Earth with its solid state, ice, and gaseous state . Water also exists in a...
(82 percent of the population) and sanitation
Sanitation
Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of wastes. Hazards can be either physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems are human and animal feces, solid wastes, domestic...
(75 percent of the population). The health care system includes 122 hospitals, 2,400 health centers, and 4 university clinics, but they are poorly maintained and lack adequate capacity to meet the demand for medical care. Only 24,000 beds are available for 6 million patients seeking care each year, including 3 million emergency cases. The health budget corresponds to 1.1 percent of gross domestic product
Gross domestic product
Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....
and 5.5 percent of the central government budget.
Netherlands
Health care in the NetherlandsHealth care in the Netherlands
Healthcare in the Netherlands is financed by a dual system that came into effect in January 2006. Long-term treatments, especially those that involve semi-permanent hospitalization, and also disability costs such as wheelchairs, are covered by a state-controlled mandatory insurance...
, has since January 2006 been provided by a system of compulsory insurance backed by a risk equalization
Risk equalization
Risk equalization is a way of equalizing the risk profiles of insurance members in order to avoid loading premiums on the insured to some predetermined extent.- Health care :...
program so that the insured are not penalized for their age or health status. This is meant to encourage competition between health care providers and insurers. Children under 18 are insured by the government, and special assistance is available to those with limited incomes. In 2005, the Netherlands spent 9.2% of GDP on health care, or US$3,560 per capita. Of that, approximately 65% was government expenditure.
New Zealand
In New ZealandNew Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...
hospitals are public and treat citizens or permanent residents, with the fees paid by the government, and are managed by District Health Boards. Under the Labour
New Zealand Labour Party
The New Zealand Labour Party is a New Zealand political party. It describes itself as centre-left and socially progressive and has been one of the two primary parties of New Zealand politics since 1935....
coalition governments (1999–2008), there were plans to make primary health care
Primary health care
Primary health care, often abbreviated as “PHC”, has been defined as "essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost...
available with charges paid for by the government. At present government subsidies exist in health care. The cost of visiting a GP ranges from government-paid to $45.00 for children and from government-paid to $75.00 for adults under the current subsidies. This system is funded by taxes. The New Zealand government agency PHARMAC subsidizes certain pharmaceuticals depending upon their category. Co-payments exist, however these are lower if the user has a Community Services Card or High User Health Card. In 2005, New Zealand spent 8.9% of GDP on health care, or US$2,403 per capita. Of that, approximately 77% was government expenditure.
Niger
Health care system of NigerNiger
Niger , officially named the Republic of Niger, is a landlocked country in Western Africa, named after the Niger River. It borders Nigeria and Benin to the south, Burkina Faso and Mali to the west, Algeria and Libya to the north and Chad to the east...
suffers from a chronic lack of resources and a small number of health providers relative to population. Some medicines are in short supply or unavailable. There are government hospitals in Niamey
Niamey
-Population:While Niamey's population has grown steadily since independence, the droughts of the early 1970s and 1980s, along with the economic crisis of the early 1980s, have propelled an exodus of rural inhabitants to Niger's largest city...
(with three main hospitals in Niamey, including the Hôpital National de Niamey and the Hôpital National De Lamordé), Maradi, Tahoua
Tahoua
Tahoua is a city in Niger and the administrative center of the Department of Tahoua and the larger Tahoua Region. It has a population of 99,900 . The city is primarily a market town for the surrounding agricultural area, and a meeting place for the Tuareg people from the north and the Fulani people...
, Zinder
Zinder
Zinder is the second largest city in Niger, with a population of 170,574 by 2005 was estimated to be over 200,000...
and other large cities, with smaller medical clinics in most towns. Medical facilities are limited in both supplies and staff, with a small government health care system supplemented by private, charitable, religious, and Non-government organisation operated clinics and public health programs (such as Galmi Hospital
Galmi Hospital
Galmi Hospital is a missions hospital administered by Serving In Mission in the Nigerien village of Galmi. Galmi Hospital is staffed by several doctors and nurses from all over the world, as well as locally-trained medical personnel. Patients travel from surrounding villages and countries to...
near Birnin Konni and Maradi). Government hospitals, as well as public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
programmes, fall under the control of the Nigerien Ministry of Health. A number of private for profit clinics ("Cabinets Médical Privé") operate in Niamey. The total expenditure on health per capita in 2005 was Intl $25. There were 377 Physicians in Niger in 2004, a ratio of 0.03 per 10,000 population. In 2003, 89.2 percent of individual expenditures on health care were "out-of-pocket" (paid by the patient).
Nigeria
Health care provision in NigeriaNigeria
Nigeria , officially the Federal Republic of Nigeria, is a federal constitutional republic comprising 36 states and its Federal Capital Territory, Abuja. The country is located in West Africa and shares land borders with the Republic of Benin in the west, Chad and Cameroon in the east, and Niger in...
is a concurrent responsibility of the three tiers of government in the country. However, because Nigeria operates a mixed economy
Mixed economy
Mixed economy is an economic system in which both the state and private sector direct the economy, reflecting characteristics of both market economies and planned economies. Most mixed economies can be described as market economies with strong regulatory oversight, in addition to having a variety...
, private providers of health care have a visible role to play in health care delivery. The federal government
Politics of Nigeria
Nigeria is a Federal Republic modeled after the United States, with executive power exercised by the president and with influences from the Westminster System model in the composition and management of the upper and lower houses of the bicameral legislature. However, the President of Nigeria is...
's role is mostly limited to coordinating the affairs of the university
University
A university is an institution of higher education and research, which grants academic degrees in a variety of subjects. A university is an organisation that provides both undergraduate education and postgraduate education...
teaching hospital
Teaching hospital
A teaching hospital is a hospital that provides clinical education and training to future and current doctors, nurses, and other health professionals, in addition to delivering medical care to patients...
s, while the state government manages the various general hospital
General hospital
A general hospital is a type of medical facility which is set up to deal with many kinds of disease and injury.General hospital may also refer to:*General Hospital, an American soap opera broadcast since 1963...
s and the local government
Local government
Local government refers collectively to administrative authorities over areas that are smaller than a state.The term is used to contrast with offices at nation-state level, which are referred to as the central government, national government, or federal government...
focus on dispensaries. The total expenditure on health care as % of GDP is 4.6, while the percentage of federal government expenditure on health care is about 1.5%. A long run indicator of the ability of the country to provide food sustenance and avoid malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
is the rate of growth of per capita food production; from 1970–1990, the rate for Nigeria was 0.25%. Though small, the positive rate of per capita may be due to Nigeria's importation of food products. Historically, health insurance in Nigeria can be applied to a few instances: government-paid health care provided and financed for all citizens, health care provided by government through a special health insurance scheme for government employees and private firms entering contracts with private health care providers. However, there are few people who fall within the three instances. In May 1999, the government created the National Health Insurance
National health insurance
National health insurance is health insurance that insures a national population for the costs of health care and usually is instituted as a program of healthcare reform. It is enforced by law. It may be administered by the public sector, the private sector, or a combination of both...
Scheme, the scheme encompasses government employees, the organized private sector
Private sector
In economics, the private sector is that part of the economy, sometimes referred to as the citizen sector, which is run by private individuals or groups, usually as a means of enterprise for profit, and is not controlled by the state...
and the informal sector. Legislative wise, the scheme also covers children under five, permanently disabled persons and prison inmates. In 2004, the administration of Obasanjo further gave more legislative powers to the scheme with positive amendments to the original 1999 legislative act.
North Korea
North KoreaNorth Korea
The Democratic People’s Republic of Korea , , is a country in East Asia, occupying the northern half of the Korean Peninsula. Its capital and largest city is Pyongyang. The Korean Demilitarized Zone serves as the buffer zone between North Korea and South Korea...
has a national medical service and health insurance system. As of 2000, some 99 percent of the population had access to sanitation
Sanitation
Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of wastes. Hazards can be either physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems are human and animal feces, solid wastes, domestic...
, and 100 percent had access to water, but water was not always potable. Medical treatment is paid for by the state. In the past, there reportedly has been one doctor for every 700 inhabitants and one hospital bed for every 350 inhabitants. Health expenditures in 2001 were 2.5 percent of gross domestic product, and 73 percent of health expenditures were made in the public sector. There were no reported human immuno-deficiency virus/acquired immune deficiency syndrome (HIV/AIDS) cases as of 2007. However, it is estimated that between 500,000 and 3 million people died from famine
Famine
A famine is a widespread scarcity of food, caused by several factors including crop failure, overpopulation, or government policies. This phenomenon is usually accompanied or followed by regional malnutrition, starvation, epidemic, and increased mortality. Every continent in the world has...
in the 1990s, and a 1998 United Nations
United Nations
The United Nations is an international organization whose stated aims are facilitating cooperation in international law, international security, economic development, social progress, human rights, and achievement of world peace...
(UN) World Food Program report revealed that 60 percent of children suffered from malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
, and 16 percent were acutely malnourished. UN statistics for the period 1999–2001 reveal that North Korea’s daily per capita food supply was one of the lowest in Asia, exceeding only that of Cambodia
Cambodia
Cambodia , officially known as the Kingdom of Cambodia, is a country located in the southern portion of the Indochina Peninsula in Southeast Asia...
, Laos
Laos
Laos Lao: ສາທາລະນະລັດ ປະຊາທິປະໄຕ ປະຊາຊົນລາວ Sathalanalat Paxathipatai Paxaxon Lao, officially the Lao People's Democratic Republic, is a landlocked country in Southeast Asia, bordered by Burma and China to the northwest, Vietnam to the east, Cambodia to the south and Thailand to the west...
, and Tajikistan
Tajikistan
Tajikistan , officially the Republic of Tajikistan , is a mountainous landlocked country in Central Asia. Afghanistan borders it to the south, Uzbekistan to the west, Kyrgyzstan to the north, and China to the east....
, and one of the lowest worldwide. Because of continuing economic problems, food shortages and chronic malnutrition prevail in the 2000s.
Norway
Norway has a government run and government financed universal health care system, coveringphysical and mental health for all and dental health for children under the age of 16. Hospitals are paid by the state and doctor visit fees are capped at a fairly low rate. Medicine is market price, but people needing the medicine more than three months a year, gets prescription with high discount. There is also a yearly cap for people with high medical expenses.
Private health care exists: Most adults use private dental care, the public only treat people, for a normal fee, when they have free capacity. Health-related plastic surgery (like burn damage) is covered by the public system, while cosmetic surgery in general is private. There are a number of private psychologists, there are also some private general practice doctors and specialists.
Public health care is financed by a special-purpose income tax on the order of 8-11%, loosely translated as "public benefits fee" (Norwegian: trygdeavgift og Folketrygden). This can be considered a mandatory public insurance, covering not only health care but also loss of income during sick leave, public pension, unemployment benefits, benefits for single parents and a few others. The system is supposed to be self-financing from the taxes.
Norwegian citizens living in Norway are automatically covered, even if they never had taxable income. Norwegian citizens living and working abroad (taxable elsewhere and therefore not paying the "public benefits fee" to Norway) are covered for up to one year after they move abroad, and must pay an estimated market cost for public health care services. Non-citizens like foreign visitors are covered in full.
According to WHO, total health care expenditure in 2005 was 9% of GDP and paid 84% by government, 15% by private out-of-pocket and ~1% by other private sources.
Oman
Oman's healthcare system was ranked at number 8 by the WHO healthcare systems rankingWHO's ranking of health care systems
The World Health Organization ranked the healthcare systems of its 191 member states in its World Health Report 2000. It provided a framework and measurement approach to examine and compare aspects of health systems around the world...
in 2000. Universal healthcare (including prescriptions and dental care) is provided automatically to all citizens and also to expatriates working in the public sector by the Ministry of Health. Non-eligible individuals such as expatriates working in the private sector and foreign visitors can be treated in the government hospitals and clinics for a reasonable fee or they can opt for the more expensive private clinics and medical centres. The Ministry of Health also finances the treatment of citizens abroad if the required treatment is not available in Oman. The life expectancy in Oman as of 2007 was 71.6. It had 1.81 doctors per 1000 pop., 1.9 beds per 1000 pop. and an infant mortality rate of 9 per 1000 live births. Health expenditure accounts for 4.5% of government revenue.
Pakistan
Pakistan's health indicators, health funding, and health and sanitationSanitation
Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of wastes. Hazards can be either physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems are human and animal feces, solid wastes, domestic...
infrastructure are generally poor, particularly in rural areas. About 19 percent of the population is malnourished—a higher rate than the 17 percent average for developing countries—and 30 percent of children under age five are malnourished. Leading causes of sickness and death include gastroenteritis
Gastroenteritis
Gastroenteritis is marked by severe inflammation of the gastrointestinal tract involving both the stomach and small intestine resulting in acute diarrhea and vomiting. It can be transferred by contact with contaminated food and water...
, respiratory infections, congenital abnormalities, tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
, malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
, and typhoid fever
Typhoid fever
Typhoid fever, also known as Typhoid, is a common worldwide bacterial disease, transmitted by the ingestion of food or water contaminated with the feces of an infected person, which contain the bacterium Salmonella enterica, serovar Typhi...
. The United Nations
United Nations
The United Nations is an international organization whose stated aims are facilitating cooperation in international law, international security, economic development, social progress, human rights, and achievement of world peace...
estimates that in 2003 Pakistan’s human immunodeficiency virus (HIV) prevalence rate was 0.1 percent among those 15–49, with an estimated 4,900 deaths from acquired immune deficiency syndrome (AIDS). AIDS is a major health concern, and both the government and religious community are engaging in efforts to reduce its spread. In 2003 there were 68 physicians for every 100,000 persons in Pakistan. According to 2002 government statistics, there were 12,501 health institutions nationwide, including 4,590 dispensaries, 906 hospitals with a total of 80,665 hospital beds, and 550 rural health centers with a total of 8,840 beds. According to the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
, Pakistan’s total health expenditures amounted to 3.9 percent of gross domestic product (GDP) in 2001, and per capita health expenditures were US$16. The government provided 24.4 percent of total health expenditures, with the remainder being entirely private, out-of-pocket expenses.
Paraguay
In terms of major indicators, health in ParaguayHealth in Paraguay
In terms of major indicators, health in Paraguay ranks near the median among South American countries. In 2003 Paraguay had a child mortality rate of 29.5 deaths per 1,000 children, ranking it behind Argentina, Colombia, and Uruguay but ahead of Brazil and Bolivia. The health of Paraguayans living...
ranks near the median among South America
South America
South America is a continent situated in the Western Hemisphere, mostly in the Southern Hemisphere, with a relatively small portion in the Northern Hemisphere. The continent is also considered a subcontinent of the Americas. It is bordered on the west by the Pacific Ocean and on the north and east...
n countries. In 2003 Paraguay
Paraguay
Paraguay , officially the Republic of Paraguay , is a landlocked country in South America. It is bordered by Argentina to the south and southwest, Brazil to the east and northeast, and Bolivia to the northwest. Paraguay lies on both banks of the Paraguay River, which runs through the center of the...
had a child mortality
Child mortality
Child mortality, also known as under-5 mortality, refers to the death of infants and children under the age of five. In 2010, 7.6 million children under five died , down from 8.1 million in 2009, 8.8 million in 2008, and 12.4 million in 1990. About half of child deaths occur in Africa....
rate of 29.5 deaths per 1,000 children, ranking it behind Argentina
Argentina
Argentina , officially the Argentine Republic , is the second largest country in South America by land area, after Brazil. It is constituted as a federation of 23 provinces and an autonomous city, Buenos Aires...
, Colombia
Colombia
Colombia, officially the Republic of Colombia , is a unitary constitutional republic comprising thirty-two departments. The country is located in northwestern South America, bordered to the east by Venezuela and Brazil; to the south by Ecuador and Peru; to the north by the Caribbean Sea; to the...
, and Uruguay
Uruguay
Uruguay ,officially the Oriental Republic of Uruguay,sometimes the Eastern Republic of Uruguay; ) is a country in the southeastern part of South America. It is home to some 3.5 million people, of whom 1.8 million live in the capital Montevideo and its metropolitan area...
but ahead of Brazil
Brazil
Brazil , officially the Federative Republic of Brazil , is the largest country in South America. It is the world's fifth largest country, both by geographical area and by population with over 192 million people...
and Bolivia
Bolivia
Bolivia officially known as Plurinational State of Bolivia , is a landlocked country in central South America. It is the poorest country in South America...
. The health of Paraguayans living outside urban areas is generally worse than those residing in cities. Many preventable diseases, such as Chagas' disease, run rampant in rural regions. Parasitic and respiratory diseases, which could be controlled with proper medical treatment, drag down Paraguay's overall health. In general, malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
, lack of proper health care, and poor sanitation
Sanitation
Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of wastes. Hazards can be either physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems are human and animal feces, solid wastes, domestic...
are the root of many health problems in Paraguay.
Health care funding from the national government increased gradually throughout the 1980s and 1990s. Spending on health care rose to 1.7 percent of the gross domestic product
Gross domestic product
Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....
(GDP) in 2000, nearly triple the 0.6 percent of GDP spent in 1989. But during the past decade, improvement in health care has slowed. Paraguay spends less per capita (US$13−20 per year) than most other Latin American countries. A 2001 survey indicated that 27 percent of the population still had no access to medical care, public or private. Private health insurance is very limited, with pre-paid plans making up only 11 percent of private expenditures on health care. Thus, most of the money spent on private health care (about 88 percent) is on a fee-for-service basis, effectively preventing the poor population from seeing private doctors. According to recent estimates, Paraguay has about 117 physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s and 20 nurses per 100,000 population.
People's Republic of China
The effective public health work in controlling epidemic disease during the early years of the PRC and, after reform began in 1978, the dramatic improvements in nutrition greatly improved the health and life expectancy of the Chinese people. The 2000 WHO World Health Report - Health systems: improving performanceWorld Health Report
The World Health Report is a series of reports produced regularly by the World Health Organization . First published in 1995, the World Health Report is WHO's leading publication...
found that China's health care system before 1980 performed far better than countries at a comparable level of development, since 1980 ranks much lower than comparable countries. The end of the famed "barefoot doctor" system was abolished in 1981.
China is undertaking a reform on its health care system
Healthcare system reform in the People's Republic of China
The healthcare system reform in the People's Republic of China refers to the healthcare system transition in modern China.The Ministry of Health of the State Council oversees the health services system, which includes a substantial rural collective sector but little private sector...
. The New Rural Co-operative Medical Care System (NRCMCS) is a new 2005 initiative to overhaul the health care 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.
Health care was provided in both rural and urban areas through a three-tiered system. In rural areas the first tier was made up of barefoot doctors working out of village medical centers. They provided preventive and primary-care services, with an average of two doctors per 1,000 people. At the next level were the township health centers, which functioned primarily as out-patient clinics for about 10,000 to 30,000 people each. These centers had about ten to thirty beds each, and the most qualified members of the staff were assistant doctors. The two lower-level tiers made up the "rural collective health system" that provided most of the country's medical care. Only the most seriously ill patients were referred to the third and final tier, the county hospitals, which served 200,000 to 600,000 people each and were staffed by senior doctors who held degrees from 5-year medical school
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...
s. Health care in urban areas was provided by paramedical personnel assigned to factories and neighborhood health stations. If more professional care was necessary the patient was sent to a district hospital, and the most serious cases were handled by municipal hospitals. To ensure a higher level of care, a number of state enterprises and government agencies sent their employees directly to district or municipal hospitals, circumventing the paramedical, or barefoot doctor, stage.
Philippines
In 2000 the PhilippinesPhilippines
The Philippines , officially known as the Republic of the Philippines , is a country in Southeast Asia in the western Pacific Ocean. To its north across the Luzon Strait lies Taiwan. West across the South China Sea sits Vietnam...
had about 95,000 physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s, or about 1 per 800 people. In 2001 there were about 1,700 hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s, of which about 40 percent were government-run and 60 percent private, with a total of about 85,000 beds, or about one bed per 900 people. The leading causes of morbidity as of 2002 were diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
, bronchitis
Bronchitis
Acute bronchitis is an inflammation of the large bronchi in the lungs that is usually caused by viruses or bacteria and may last several days or weeks. Characteristic symptoms include cough, sputum production, and shortness of breath and wheezing related to the obstruction of the inflamed airways...
, pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
, influenza
Influenza
Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae , that affects birds and mammals...
, hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
, tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
, heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
, malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
, chickenpox
Chickenpox
Chickenpox or chicken pox is a highly contagious illness caused by primary infection with varicella zoster virus . It usually starts with vesicular skin rash mainly on the body and head rather than at the periphery and becomes itchy, raw pockmarks, which mostly heal without scarring...
, and measles
Measles
Measles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...
. Cardiovascular diseases account for more than 25 percent of all deaths. According to official estimates, 1,965 cases of human immunodeficiency virus (HIV) were reported in 2003, of which 636 had developed acquired immune deficiency syndrome (AIDS). Other estimates state that there may have been as many as 9,400 people living with HIV/AIDS in 2001.
Romania
Health care public system has been improved but it is still poor by European standards, and access is limited in rural areas. In 2007 health expenditures were equal to 3.9 percent of gross domestic product. In 2007 there were 2.2 physicians and 6.4 hospital beds per 1,000 people. The system is funded by the National Health Care Insurance Fund, to which employers and employees make mandatory contributions. Private health care system has developed slowly but now consists of 22 private hospitals and more than 240 clinics.Russia
Article 41 of the Constitution of the Russian Federation confirms a citizen's right to state healthcare and medical assistance paid for by the government. This is achieved through state compulsory medical insurance (OMS) which is paid for by the government, to Russian citizens, funded by obligatory medical insurance payments made by companies and government subsidies. 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 PutinVladimir Putin
Vladimir Vladimirovich Putin served as the second President of the Russian Federation and is the current Prime Minister of Russia, as well as chairman of United Russia and Chairman of the Council of Ministers of the Union of Russia and Belarus. He became acting President on 31 December 1999, when...
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. He also said that obligatory medical insurance tax paid by companies will increase from current 3.1% to 5.1% starting from 2011.
Senegal
The health budget in Senegal has tripled between 1980 and 2000, leading to the Senegalese people leading healthier and longer lives - the life expectancy at birth is approximately 55.34 years for men, 58.09 years for women, and 56.69 years for the entire population. Also, the prevalence rate of AIDS in Senegal is one of the lowest in Africa, at 0.9%. However, large disparities still exist in Senegal's health coverage, with 70% of doctors, and 80% of pharmacists and dentists, living in the nation's capital city, Dakar.Singapore
Health care in SingaporeHealth care in Singapore
Healthcare in Singapore is mainly under the responsibility of the Singapore Government's Ministry of Health. Singapore generally has an efficient and widespread system of healthcare...
is mainly under the responsibility of the Singapore Government's Ministry of Health
Ministry of Health (Singapore)
The Ministry of Health is a ministry of the Government of Singapore responsible for providing information, raising health awareness and education, ensuring the accessibility of health services, and monitoring the quality of health services provided to citizens and visitors in the Republic of...
. Singapore generally has an efficient and widespread system of health care. It implements a universal health care
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.-History:...
system, and co-exists with private health care system. Infant mortality
Infant mortality
Infant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying...
rate: in 2006 the crude birth rate stood at 10.1 per 1000, a very low level attributed to birth control policies, and the crude death rate was also one of the lowest in the world at 4.3 per 1000. In 2006, the total fertility rate was only 1.26 children per woman, the 3rd lowest in the world and well below the 2.10 needed to replace the population. Singapore was ranked 6th in the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
's ranking of the world's health systems in the year 2000.
Singapore
Singapore
Singapore , officially the Republic of Singapore, is a Southeast Asian city-state off the southern tip of the Malay Peninsula, north of the equator. An island country made up of 63 islands, it is separated from Malaysia by the Straits of Johor to its north and from Indonesia's Riau Islands by the...
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. Singapore currently has the lowest infant mortality rate in the world (equaled only by Iceland) and among the highest life expectancies from birth, according to the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
. Singapore has "one of the most successful health care 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
Watson Wyatt Worldwide
Watson Wyatt Worldwide, Inc. was a global consulting firm, which merged in January 2010 with Towers Perrin to form Towers Watson. The firm's services included managing the cost and effectiveness of employee benefit programs; developing attraction, retention and reward strategies; advising pension...
. Singapore's system uses a combination of compulsory savings from payroll deductions (funded by both employers and workers) a nationalized catastrophic health insurance plan, and government subsidies, as well as "actively regulating the supply and prices of health care 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.
Singapore’s well-established health care system comprises a total of 13 private hospitals, 10 public (government) hospitals and several specialist clinics, each specializing in and catering to different patient needs, at varying costs.
Patients are free to choose the providers within the government or private health care delivery system and can walk in for a consultation at any private clinic or any government polyclinic. For emergency services, patients can go at any time to the 24-hour Accident & Emergency Departments located in the government hospitals.
Singapore's medical facilities are among the finest in the world, with well qualified doctors and dentists, many trained overseas.
Singapore has medical savings account
Medical savings account
Medical savings account refers to an account in which tax-deferred deposits can be made for medical expenses.-In Singapore:Medisave was introduced in April 1984 as a national medical savings system for Singaporeans...
system known as Medisave
Medisave
Medisave was introduced in April 1984 as a national medical savings account system for Singaporeans. The system allows Singaporeans to put aside part of their income into a Medisave account to meet future personal or immediate family's hospitalization, day surgery and for certain outpatient...
.
South Africa
In South AfricaSouth Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...
, parallel private and public systems exist. The public system serves the vast majority of the population, but is chronically underfunded and understaffed. The wealthiest 20% of the population uses the private system and are far better served. This division in substantial ways perpetuates racial inequalities created in the pre-apartheid segregation era and apartheid era of the 20th century. In 2005, South Africa spent 8.7% of GDP on health care, or US$437 per capita. Of that, approximately 42% was government expenditure.
Sudan
Outside urban areas, little health care is available in SudanSudan
Sudan , officially the Republic of the Sudan , is a country in North Africa, sometimes considered part of the Middle East politically. It is bordered by Egypt to the north, the Red Sea to the northeast, Eritrea and Ethiopia to the east, South Sudan to the south, the Central African Republic to the...
, helping account for a relatively low average life expectancy
Life expectancy
Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...
of 57 years and an infant mortality
Infant mortality
Infant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying...
rate of 69 deaths per 1,000 live births, low by standards in Middle Eastern but not African countries. For most of the period since independence in 1956, Sudan has experienced civil war
Civil war
A civil war is a war between organized groups within the same nation state or republic, or, less commonly, between two countries created from a formerly-united nation state....
, which has diverted resources to military use that otherwise might have gone into health care and training of professionals, many of whom have migrated in search of more gainful employment. In 1996 the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
estimated that there were only 9 doctors per 100,000 people, most of them in regions other than the South. Substantial percentages of the population lack access to safe water and sanitary facilities. Malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
is widespread outside the central Nile corridor because of population displacement from war and from recurrent droughts; these same factors together with a scarcity of medicines make diseases difficult to control. Child immunization against most major childhood diseases, however, had risen to approximately 60 percent by the late 1990s from very low rates in earlier decades. Spending on health care is quite low—only 1 percent of gross domestic product
Gross domestic product
Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....
(GDP) in 1998 (latest data). The United Nations
United Nations
The United Nations is an international organization whose stated aims are facilitating cooperation in international law, international security, economic development, social progress, human rights, and achievement of world peace...
placed the rate of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) infection in late 2003 at 2.3 percent for adults, quite low by regional standards. The United Nations suggested, however, that the rate could be as high as 7.2 percent. Between 400,000 and 1.3 million adults and children were living with HIV, and AIDS deaths numbered 23,000. As of late 2004, some 4 million persons in the South had been internally displaced and more than 2 million had died or been killed as a result of two decades of war. Comparable figures for Darfur
Darfur
Darfur is a region in western Sudan. An independent sultanate for several hundred years, it was incorporated into Sudan by Anglo-Egyptian forces in 1916. The region is divided into three federal states: West Darfur, South Darfur, and North Darfur...
were 1.6 million displaced and 70,000 dead since fighting began there in early 2003.
Sweden
The SwedishSweden
Sweden , officially the Kingdom of Sweden , is a Nordic country on the Scandinavian Peninsula in Northern Europe. Sweden borders with Norway and Finland and is connected to Denmark by a bridge-tunnel across the Öresund....
public health system is funded through taxes levied by the county councils
County Councils of Sweden
A county council, or landsting, is an elected assembly of a county in Sweden. A county council is a political entity, elected by the county electorate and typically its main responsibilities lie within the public health care system. In each county there is also a county administrative board which...
. There is a fixed charge of SEK 150 (USD 21) for each visit to a doctor or a hospital, limited to SEK 800 (USD 111) per year, and prescription charges are limited to 1,800 SEK (= 249 USD) per year. Government-paid dental care for children under 21 years old is included in the system, and dental care for grown-ups is partly subsidised by it.
Sweden also has a smaller private health care sector, mainly in larger cities or as centers for preventive health care financed by employers.
Switzerland
In SwitzerlandSwitzerland
Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....
, compulsory health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
covers the costs of medical treatment and hospitalization of the insured. The Swiss healthcare system is a combination of public, subsidized private and totally private healthcare providers, where the insured person has full freedom of choice among the providers in his region. Insurance companies independently set their price points for different age groups, but are forbidden from setting prices based on health risk. In 2000, Switzerland topped all European countries’ health care expenditure when calculated as per capita expenditure in US dollar purchasing parity terms.
The Swiss health care system is interesting as it was the last for-profit system in Europe. In the 1990s, after the private carriers began to deny coverage for pre-existing conditions—and when the uninsured population of Switzerland reached 5%--the Swiss held a referendum (1995) and adopted their present system.
Syria
The Baath PartyBaath Party
The Arab Socialist Ba'ath Party was a political party mixing Arab nationalist and Arab socialist interests, opposed to Western imperialism, and calling for the renaissance or resurrection and unification of the Arab world into a single state. Ba'ath is also spelled Ba'th or Baath and means...
has placed an emphasis on health care
Health care
Health care 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...
, but funding levels have not been able to keep up with demand or maintain quality. Health expenditures reportedly accounted for 2.5 percent of the gross domestic product
Gross domestic product
Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....
(GDP) in 2001. Syria’s health system is relatively decentralized and focuses on offering primary health care at three levels: village, district, and provincial. According to the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(WHO), in 1990 Syria had 41 general hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s (33 public, 8 private), 152 specialized hospitals (16 public, 136 private), 391 rural health centers, 151 urban health centers, 79 rural health units, and 49 specialized health centers; hospital bed
Hospital bed
A hospital bed is a bed specially designed for hospitalized patients or others in need of some form of health care. These beds have special features both for the comfort and well-being of the patient and for the convenience of health care workers...
s totaled 13,164 (77 percent public, 23 percent private), or 11 beds per 10,000 inhabitants. The number of state hospital beds reportedly fell between 1995 and 2001, while the population had an 18 percent increase, but the opening of new hospitals in 2002 caused the number of hospital beds to double. WHO reported that in 1989 Syria had a total of 10,114 physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s, 3,362 dentist
Dentist
A dentist, also known as a 'dental surgeon', is a doctor that specializes in the diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aides in providing oral health services...
s, and 14,816 nurses and midwives; in 1995 the rate of health professionals per 10,000 inhabitants was 10.9 physicians, 5.6 dentists, and 21.2 nurses and midwives. Despite overall improvements, Syria’s health system exhibits significant regional disparities in the availability of health care, especially between urban and rural areas. The number of private hospitals and doctors increased by 41 percent between 1995 and 2001 as a result of growing demand and growing wealth in a small sector of society. Almost all private health facilities are located in large urban areas such as Damascus
Damascus
Damascus , commonly known in Syria as Al Sham , and as the City of Jasmine , is the capital and the second largest city of Syria after Aleppo, both are part of the country's 14 governorates. In addition to being one of the oldest continuously inhabited cities in the world, Damascus is a major...
, Aleppo
Aleppo
Aleppo is the largest city in Syria and the capital of Aleppo Governorate, the most populous Syrian governorate. With an official population of 2,301,570 , expanding to over 2.5 million in the metropolitan area, it is also one of the largest cities in the Levant...
, Tartus, and Latakia
Latakia
Latakia, or Latakiyah , is the principal port city of Syria, as well as the capital of the Latakia Governorate. In addition to serving as a port, the city is a manufacturing center for surrounding agricultural towns and villages...
.
Taiwan
The current health care system in TaiwanTaiwan
Taiwan , also known, especially in the past, as Formosa , is the largest island of the same-named island group of East Asia in the western Pacific Ocean and located off the southeastern coast of mainland China. The island forms over 99% of the current territory of the Republic of China following...
, 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. 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. Most health providers operate in the private sector and form a competitive market on the health delivery side. However, many health care providers took advantage of the system by offering unnecessary services to a larger number of patients and then billing the government. In the face of increasing loss and the need for cost containment , NHI changed the payment system from fee-for-service to a global budget, a kind of prospective payment system, in 2002.
According to T.R. Reid
T.R. Reid
T. R. Reid is an American reporter, documentary film correspondent, and author. He is also a frequent guest on National Public Radio 's Morning Edition. He is married to attorney Margaret M. McMahon, with whom he has three children...
, Taiwan achieves "remarkable efficiency", costing ~6 percent of GDP universal coverage
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.-History:...
; however, this underestimates the cost as it is not fully funded and the government is forced to borrow to make up the difference. "And frankly, the solution is fairly obvious: increase the spending a little, to maybe 8 percent of GDP. Of course, if Taiwan did that, it would still be spending less than half of what America spends." And then, as with the American government Medicare and Medicaid, it would be "obvious" that the government spending needed to be increased every year. The "solution" to government borrowing being to increase government spending.
Thailand
Data on health care is out of date, but in 1995 ThailandThailand
Thailand , officially the Kingdom of Thailand , formerly known as Siam , is a country located at the centre of the Indochina peninsula and Southeast Asia. It is bordered to the north by Burma and Laos, to the east by Laos and Cambodia, to the south by the Gulf of Thailand and Malaysia, and to the...
had 0.3 physicians and 1.9 hospital beds per 1,000 population. In 2002 annual spending on health care amounted to US$321 per person in purchasing power parity
Purchasing power parity
In economics, purchasing power parity is a condition between countries where an amount of money has the same purchasing power in different countries. The prices of the goods between the countries would only reflect the exchange rates...
(PPP). Total expenditures represented about 4.4 percent of the gross domestic product
Gross domestic product
Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....
(GDP); of this amount, 57.1 percent came from public sources and 42.9 percent from private sources. Some 85 percent of the population had access to potable water in 2002, and 99 percent had access to sanitation
Sanitation
Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of wastes. Hazards can be either physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems are human and animal feces, solid wastes, domestic...
. Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is a serious problem in Thailand. The United Nations Programme on HIV/AIDS (UNAIDS) reported in November 2004 that the Thai government had launched a well-funded, politically supported, and pragmatic response to the epidemic. As a result, national adult HIV prevalence has decreased to an estimated 1.5 percent of all persons aged 15 to 49 years (or about 1.8 percent of the total population). It was also reported that 58,000 adults and children had died from AIDS since the first case was reported in 1984. The government has begun to improve its support to persons with HIV/AIDS and has provided funds to HIV/AIDS support groups. Public programs have begun to alter unsafe behavior, but discrimination against those infected continues. The government has funded an antiretroviral drug program and, as of September 2006, more than 80,000 HIV/AIDS patients had received such drugs. Highly pathogenic H5N1 avian influenza (bird flu) has been found among birds in Thailand as well as surrounding areas. The government has pledged financial support for the prevention effort, which mainly focuses on changing poultry farming methods. Major infectious diseases in Thailand also include bacterial diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
, hepatitis
Hepatitis
Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...
, dengue fever
Dengue fever
Dengue fever , also known as breakbone fever, is an infectious tropical disease caused by the dengue virus. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles...
, malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
, Japanese encephalitis
Japanese Encephalitis
Japanese encephalitis —previously known as Japanese B encephalitis to distinguish it from von Economo's A encephalitis—is a disease caused by the mosquito-borne Japanese encephalitis virus. The Japanese encephalitis virus is a virus from the family Flaviviridae. Domestic pigs and wild birds are...
, rabies
Rabies
Rabies is a viral disease that causes acute encephalitis in warm-blooded animals. It is zoonotic , most commonly by a bite from an infected animal. For a human, rabies is almost invariably fatal if post-exposure prophylaxis is not administered prior to the onset of severe symptoms...
, and leptospirosis
Leptospirosis
Leptospirosis is caused by infection with bacteria of the genus Leptospira, and affects humans as well as other mammals, birds, amphibians, and reptiles.The...
.
Thailand
Thailand
Thailand , officially the Kingdom of Thailand , formerly known as Siam , is a country located at the centre of the Indochina peninsula and Southeast Asia. It is bordered to the north by Burma and Laos, to the east by Laos and Cambodia, to the south by the Gulf of Thailand and Malaysia, and to the...
introduced universal coverage reforms in 2001, becoming one of only a handful of lower-middle income countries to do so. 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. 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 state-paid. It is not yet clear whether the scheme will be modified further under the coalition government that came to power in January 2008.
Trinidad and Tobago
Trinidad and TobagoTrinidad and Tobago
Trinidad and Tobago officially the Republic of Trinidad and Tobago is an archipelagic state in the southern Caribbean, lying just off the coast of northeastern Venezuela and south of Grenada in the Lesser Antilles...
operates under a two-tier health-care system. That is, there is the existence of both private health-care facilities and public health-care facilities.
The Ministry of Health is responsible for leading the health sector. The service provision aspect of public health care has been devolved to newly created entities, the Regional Health Authorities (RHAs). The Ministry of Health is shifting its focus to concentrate on policy development, planning, monitoring and evaluation, regulation, financing and research. Citizens can access government-paid health care at public health care facilities where health insurance is not required. The health-care system in the country is universal as almost all citizens utilise the services provided. Some, though, opt for private health-care facilities for their ailments.
Recently, the government of Trinidad and Tobago has launched CDAP (Chronic Disease Assistance Programme). The Chronic Disease Assistance Programme provides citizens with government-paid prescription drugs and other pharmaceutical items to combat several health conditions.
Turkmenistan
In the post-Soviet era, reduced funding has put the health system in poor condition. In 2002 TurkmenistanTurkmenistan
Turkmenistan , formerly also known as Turkmenia is one of the Turkic states in Central Asia. Until 1991, it was a constituent republic of the Soviet Union, the Turkmen Soviet Socialist Republic . Turkmenistan is one of the six independent Turkic states...
had 50 hospital beds per 10,000 population, less than half the number in 1996. Overall policy has targeted specialized inpatient facilities to the detriment of basic, outpatient care. Since the late 1990s, many rural facilities have closed, making care available principally in urban areas. President Niyazov’s 2005 proposal to close all hospitals outside Ashgabat intensified this trend. Physicians are poorly trained, modern medical techniques are rarely used, and medications are in short supply. In 2004 Niyazov dismissed 15,000 medical professionals, exacerbating the shortage of personnel. In some cases, professionals have been replaced by military conscripts. Private health care is rare, as the state maintains a near monopoly. Government-paid public health care was abolished in 2004.
United Kingdom
The four countries of the United KingdomCountries of the United Kingdom
Countries of the United Kingdom is a term used to describe England, Northern Ireland, Scotland and Wales. These four countries together form the sovereign state of the United Kingdom of Great Britain and Northern Ireland, which is also described as a country. The alternative terms, constituent...
have separate but co-operating public health care systems that were created in 1948: in England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
the public health system is known as the National Health Service
National Health Service (England)
The National Health Service or NHS is the publicly funded healthcare system in England. It is both the largest and oldest single-payer healthcare system in the world. It is able to function in the way that it does because it is primarily funded through the general taxation system, similar to how...
, in Scotland
Scotland
Scotland is a country that is part of the United Kingdom. Occupying the northern third of the island of Great Britain, it shares a border with England to the south and is bounded by the North Sea to the east, the Atlantic Ocean to the north and west, and the North Channel and Irish Sea to the...
it is known as NHS Scotland
NHS Scotland
NHS Scotland is the publicly funded healthcare system of Scotland. Although they are separate bodies the organisational separation between NHS Scotland and the other three healthcare organisations each commonly called the National Health Service in the United Kingdom tends to be hidden from its...
, in Wales
Wales
Wales is a country that is part of the United Kingdom and the island of Great Britain, bordered by England to its east and the Atlantic Ocean and Irish Sea to its west. It has a population of three million, and a total area of 20,779 km²...
as NHS Wales (GIG Cymru), and in Northern Ireland
Northern Ireland
Northern Ireland is one of the four countries of the United Kingdom. Situated in the north-east of the island of Ireland, it shares a border with the Republic of Ireland to the south and west...
it is called Health and Social Care in Northern Ireland. All four provide state-paid healthcare to all UK residents, paid for from general taxation. Though the public systems dominate, private health care and a wide variety of alternative and complementary treatments are available for those who have private health insurance or are willing to pay directly themselves.
The main difference between the four public health care systems is the patient cost for prescriptions. Wales, Northern Ireland and Scotland have recently abolished, or are in the process of abolishing, all prescription charges, while England (with the exception of birth control pills, which are paid for by the state) continues to charge patients who are between 16 and 60 years old a fixed prescription fee of £7.40 per item, unless they are exempt because of certain medical conditions (including cancer) or are on low income. Since health care delivery is a devolved matter
Devolution
Devolution is the statutory granting of powers from the central government of a sovereign state to government at a subnational level, such as a regional, local, or state level. Devolution can be mainly financial, e.g. giving areas a budget which was formerly administered by central government...
, considerable differences are developing between the systems in each of the countries.
United States
The United States currently operates under a mixed market health care system. Government sources (federal, state, and local) account for 45% of U.S. health care expenditures. Private sources account for the remainder of costs, with 38% of people receiving health coverage through their employers and 17% arising from other private payment such as private insurance and out-of-pocket co-pays. Health care reform in the United StatesHealth care reform in the United States
Health care reform in the United States has a long history, of which the most recent results were two federal statutes enacted in 2010: the Patient Protection and Affordable Care Act , signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010 , which amended the PPACA and...
usually focuses around three suggested systems, with proposals currently underway to integrate these systems in various ways to provide a number of health care options. First is single-payer
Single-payer health care
Single-payer health care is medical care funded from a single insurance pool, run by the state. Under a single-payer system, universal health care for an entire population can be financed from a pool to which many parties employees, employers, and the state have contributed...
, a term meant to describe a single agency managing a single system, as found in most modernized countries as well as some states and municipalities within the United States. Second are employer or individual insurance mandates. Finally, there is consumer-driven health, in which systems, consumers, and patients have more control of how they access care. Over the past thirty years, most of the nation's health care has moved from the second model operating with not-for-profit institutions to the third model operating with for-profit institutions.
In the US, the social and political issues surrounding access to health care have led to vigorous public debate and the almost colloquial use of terms such as health care (medical management of illness), health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
(reimbursement of health care costs), and public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
(the collective state and range of health in a population). In the US, 12% to 16% of the citizens do not have health insurance. State boards and the Department of Health regulate inpatient care to reduce the national health care deficit. To tackle the problems of the perpetually increasing number of uninsured, and costs associated with the US health care system, President Barack Obama
Barack Obama
Barack Hussein Obama II is the 44th and current President of the United States. He is the first African American to hold the office. Obama previously served as a United States Senator from Illinois, from January 2005 until he resigned following his victory in the 2008 presidential election.Born in...
says he favors the creation of a universal health care system. However, this view is not shared across the country (see, for example, quotes from New York Times opinion columnist Paul Krugman
Paul Krugman
Paul Robin Krugman is an American economist, professor of Economics and International Affairs at the Woodrow Wilson School of Public and International Affairs at Princeton University, Centenary Professor at the London School of Economics, and an op-ed columnist for The New York Times...
and Factcheck.org).
A few states have taken serious steps toward universal health care coverage, most notably Minnesota
Minnesota
Minnesota is a U.S. state located in the Midwestern United States. The twelfth largest state of the U.S., it is the twenty-first most populous, with 5.3 million residents. Minnesota was carved out of the eastern half of the Minnesota Territory and admitted to the Union as the thirty-second state...
, Massachusetts
Massachusetts
The Commonwealth of Massachusetts is a state in the New England region of the northeastern United States of America. It is bordered by Rhode Island and Connecticut to the south, New York to the west, and Vermont and New Hampshire to the north; at its east lies the Atlantic Ocean. As of the 2010...
and Connecticut
Connecticut
Connecticut is a state in the New England region of the northeastern United States. It is bordered by Rhode Island to the east, Massachusetts to the north, and the state of New York to the west and the south .Connecticut is named for the Connecticut River, the major U.S. river that approximately...
, with recent examples being the Massachusetts 2006 Health Reform Statute and Connecticut's SustiNet
SustiNet
SustiNet is a Connecticut health care plan passed into law in July, 2009. Its goal is to provide affordable health care coverage to 98% of Connecticut residents by 2014.-Provisions of the legislation:...
plan to provide quality, affordable health care to state residents.
The state of Oregon and the city of San Francisco are both examples of governments that adopted universal healthcare systems for strictly fiscal reasons.
The United States is alone among developed nations in not having a universal health care
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.-History:...
system; the 2010 Patient Protection and Affordable Care Act
Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act is a United States federal statute signed into law by President Barack Obama on March 23, 2010. The law is the principal health care reform legislation of the 111th United States Congress...
provides for a nationwide health insurance exchange
Health insurance exchange
A health insurance exchange is a set of state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance that is eligible for Federal subsidies...
by 2014, but this is not universal in the way similar countries mean it. Healthcare in the U.S. does, however, have significant publicly funded components. Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
covers the elderly and disabled with a historical work record, Medicaid
Medicaid
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...
is available for some, but not all of the poor, and the State Children's Health Insurance Program
State Children's Health Insurance Program
The State Children's Health Insurance Program – later known more simply as the Children's Health Insurance Program – is a program administered by the United States Department of Health and Human Services that provides matching funds to states for health insurance to families with children...
covers children of low-income families. The Veterans Health Administration
Veterans Health Administration
The Veterans Health Administration is the component of the United States Department of Veterans Affairs led by the Under Secretary of Veterans Affairs for Health that implements the medical assistance program of the VA through the administration and operation of numerous VA outpatient clinics,...
directly provides health care to U.S. military veterans through a nationwide network of government hospitals; while active duty service members, retired service members and their dependents are eligible for benefits through TRICARE
TRICARE
TRICARE, formerly known as the Civilian Health and Medical Program of the Uniformed Services , is a health care program of the United States Department of Defense Military Health System. TRICARE provides civilian health benefits for military personnel, military retirees, and their dependents,...
. Together, these tax-financed programs cover 27.8% of the population and make the government the largest health insurer in the nation.
United Arab Emirates
Standards of health care are considered to be generally high in the United Arab EmiratesUnited Arab Emirates
The United Arab Emirates, abbreviated as the UAE, or shortened to "the Emirates", is a state situated in the southeast of the Arabian Peninsula in Western Asia on the Persian Gulf, bordering Oman, and Saudi Arabia, and sharing sea borders with Iraq, Kuwait, Bahrain, Qatar, and Iran.The UAE is a...
, resulting from increased government spending during strong economic years. According to the UAE government, total expenditures on health care from 1996 to 2003 were US$436 million. According to the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
, in 2004 total expenditures on health care constituted 2.9 percent of gross domestic product
Gross domestic product
Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....
(GDP), and the per capita expenditure for health care was US$497. Health care currently is government-paid only for UAE citizens. Effective January 2006, all residents of Abu Dhabi
Abu Dhabi
Abu Dhabi , literally Father of Gazelle, is the capital and the second largest city of the United Arab Emirates in terms of population and the largest of the seven member emirates of the United Arab Emirates. Abu Dhabi lies on a T-shaped island jutting into the Persian Gulf from the central western...
are covered by a new comprehensive health insurance program; costs will be shared between employers and employees. The number of doctors
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
per 100,000 (annual average, 1990–99) is 181. The UAE now has 40 public hospitals, compared with only seven in 1970. The Ministry of Health is undertaking a multimillion-dollar program to expand health facilities⎯hospitals, medical centers, and a trauma center⎯in the seven emirates. A state-of-the-art general hospital has opened in Abu Dhabi with a projected bed capacity of 143, a trauma unit, and the first home health care program in the UAE. To attract wealthy UAE nationals and expatriates who traditionally have traveled abroad for serious medical care, Dubai is developing Dubai Healthcare City, a hospital free zone that will offer international-standard advanced private health care and provide an academic medical training center; completion is scheduled for 2010.
Uzbekistan
In the post-Soviet era, the quality of UzbekistanUzbekistan
Uzbekistan , officially the Republic of Uzbekistan is a doubly landlocked country in Central Asia and one of the six independent Turkic states. It shares borders with Kazakhstan to the west and to the north, Kyrgyzstan and Tajikistan to the east, and Afghanistan and Turkmenistan to the south....
’s health care
Health care
Health care 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...
has declined. Between 1992 and 2003, spending on health care and the ratio of hospital beds to population both decreased by nearly 50 percent, and Russian emigration
Emigration
Emigration is the act of leaving one's country or region to settle in another. It is the same as immigration but from the perspective of the country of origin. Human movement before the establishment of political boundaries or within one state is termed migration. There are many reasons why people...
in that decade deprived the health system of many practitioners. In 2004 Uzbekistan had 53 hospital beds per 10,000 population. Basic medical supplies such as disposable needle
Hypodermic needle
A hypodermic needle is a hollow needle commonly used with a syringe to inject substances into the body or extract fluids from it...
s, anesthetics, and antibiotics are in very short supply. Although all citizens nominally are entitled to free health care, in the post-Soviet era bribery
Bribery
Bribery, a form of corruption, is an act implying money or gift giving that alters the behavior of the recipient. Bribery constitutes a crime and is defined by Black's Law Dictionary as the offering, giving, receiving, or soliciting of any item of value to influence the actions of an official or...
has become a common way to bypass the slow and limited service of the state system. In the early 2000s, policy has focused on improving primary health care facilities and cutting the cost of inpatient facilities. The state budget for 2006 allotted 11.1 percent to health expenditures, compared with 10.9 percent in 2005.
Venezuela
The right to health care is guaranteed in the Venezuelan Constitution. Government campaigns for the prevention, elimination, and control of major health hazards have been generally successful. Immunization campaigns have systematically improved children's health, and regular campaigns to destroy disease-bearing insects and to improve water and sanitary facilities have all boosted Venezuela's health indicators to some of the highest levels in Latin America. The availability of low- or no-cost health care provided by the Venezuelan Institute of Social Security has also made Venezuela's health care infrastructure one of the more advanced in the region. However, despite being the most comprehensive and well funded in the region, the health care system has deteriorated sharply since the 1980s. Government expenditures on health care constituted an estimated 4.1 percent of gross domestic product in 2002. Total health expenditures per capita in 2001 totaled US$386. Per capita government expenditures on health in 2001 totaled US$240.Vietnam
The overall quality of health in VietnamVietnam
Vietnam – sometimes spelled Viet Nam , officially the Socialist Republic of Vietnam – is the easternmost country on the Indochina Peninsula in Southeast Asia. It is bordered by China to the north, Laos to the northwest, Cambodia to the southwest, and the South China Sea –...
is regarded as good, as reflected by 2005 estimates of life expectancy
Life expectancy
Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...
(70.61 years) and infant mortality (25.95 per 1,000 live births). However, malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
is still common in the provinces, and the life expectancy and infant mortality
Infant mortality
Infant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying...
rates are stagnating. In 2001 government spending on health care corresponded to just 0.9 percent of gross domestic product
Gross domestic product
Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....
(GDP). Government subsidies covered only about 20 percent of health care expenses, with the remaining 80 percent coming out of individuals’ own pockets.
In 1954 the government in the North established a public health system that reached down to the hamlet level. After reunification in 1976, this system was extended to the South. Beginning in the late 1980s, the quality of health care began to decline as a result of budgetary constraints, a shift of responsibility to the provinces, and the introduction of charges. Inadequate funding has led to delays in planned upgrades to water supply
Water supply
Water supply is the provision of water by public utilities, commercial organisations, community endeavours or by individuals, usually via a system of pumps and pipes...
and sewage
Sewage
Sewage is water-carried waste, in solution or suspension, that is intended to be removed from a community. Also known as wastewater, it is more than 99% water and is characterized by volume or rate of flow, physical condition, chemical constituents and the bacteriological organisms that it contains...
systems. As a result, almost half the population has no access to clean water, a deficiency that promotes such infectious diseases as malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
, dengue fever
Dengue fever
Dengue fever , also known as breakbone fever, is an infectious tropical disease caused by the dengue virus. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles...
, typhoid, and cholera
Cholera
Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces...
. Inadequate funding also has contributed to a shortage of nurses, midwives, and hospital beds. In 2000 Vietnam had only 250,000 hospital beds, or 14.8 beds per 10,000 people, a very low ratio among Asian nations, according to the World Bank
World Bank
The World Bank is an international financial institution that provides loans to developing countries for capital programmes.The World Bank's official goal is the reduction of poverty...
.
Yemen
Despite the significant progress YemenYemen
The Republic of Yemen , commonly known as Yemen , is a country located in the Middle East, occupying the southwestern to southern end of the Arabian Peninsula. It is bordered by Saudi Arabia to the north, the Red Sea to the west, and Oman to the east....
has made to expand and improve its health care system over the past decade, the system remains severely underdeveloped. Total expenditures on health care in 2002 constituted 3.7 percent of gross domestic product
Gross domestic product
Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....
. In that same year, the per capita expenditure for health care was very low, as compared with other Middle East
Middle East
The Middle East is a region that encompasses Western Asia and Northern Africa. It is often used as a synonym for Near East, in opposition to Far East...
ern countries—US$58 according to United Nations
United Nations
The United Nations is an international organization whose stated aims are facilitating cooperation in international law, international security, economic development, social progress, human rights, and achievement of world peace...
statistics and US$23 according to the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
. According to the World Bank
World Bank
The World Bank is an international financial institution that provides loans to developing countries for capital programmes.The World Bank's official goal is the reduction of poverty...
, the number of doctors
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
in Yemen rose by an average of more than 7 percent between 1995 and 2000, but as of 2004 there were still only three doctors per 10,000 persons. In 2003 Yemen had only 0.6 hospital beds available per 1,000 persons. Health care services are particularly scarce in rural areas; only 25 percent of rural areas are covered by health services, as compared with 80 percent of urban areas. Emergency services, such as ambulance
Ambulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
service and blood banks, are non-existent. Most childhood deaths are caused by illnesses for which vaccines exist or that are otherwise preventable. According to the Joint United Nations Programme on HIV/AIDS
Joint United Nations Programme on HIV/AIDS
The Joint United Nations Programme on HIV and AIDS, or UNAIDS, is the main advocate for accelerated, comprehensive and coordinated global action on the HIV epidemic....
, in 2003 an estimated 12,000 people in Yemen were living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS).
Zimbabwe
Zimbabwe now has one of the lowest life expectancies on Earth - 44 for men and 43 for women, down from 60 in 1990. The rapid drop has been ascribed mainly to the HIV/AIDS pandemicHIV/AIDS in Zimbabwe
Recent estimates from the Joint United Nations Programme on HIV/AIDS indicate that approximately 1.6 million adults 15 years and older were living with HIV/AIDS in 2005...
. Infant mortality
Infant mortality
Infant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying...
has risen from 59 per thousand in the late 1990s to 123 per 1000 by 2004. The health system has more or less collapsed: By the end of November 2008, three of Zimbabwe's four major hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s had shut down, along with the Zimbabwe Medical School
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...
and the fourth major hospital had two wards and no operating theatre
Operating theatre
An operating theater was a non-sterile, tiered theater or amphitheater in which students and other spectators could watch surgeons perform surgery...
s working. Due to hyperinflation
Hyperinflation in Zimbabwe
Hyperinflation in Zimbabwe began shortly after destruction of productive capacity in Zimbabwe's civil war and confiscation of white-owned farmland. Food output capacity fell 45%, manufacturing output 29% in 2005, 26% in 2006 and 28% in 2007, and unemployment rose to 80%...
, those hospitals still open are not able to obtain basic drugs and medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
s. The ongoing political and economic crisis also contributed to the emigration
Emigration
Emigration is the act of leaving one's country or region to settle in another. It is the same as immigration but from the perspective of the country of origin. Human movement before the establishment of political boundaries or within one state is termed migration. There are many reasons why people...
of the doctors and people with medical knowledge. In August 2008, large areas of Zimbabwe were struck by the ongoing cholera
Cholera
Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces...
epidemic
Epidemic
In epidemiology, an epidemic , occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience...
.
See also
- Alliance for Healthy CitiesAlliance for Healthy CitiesThe Alliance for Healthy Cities is a cooperative international alliance aimed at protecting and enhancing the health and health care of city dwellers. It is composed of groups of cities, urban districts and other organizations from countries around the world in exchanging information to achieve...
- Comparison of the health care systems in Canada and the United States
- Consumer-driven health care
- Globalization and HealthGlobalization and HealthGlobalization and Health is an open-access peer-reviewed medical journal that covering the topic of globalization and its effects on health. It is affiliated with the London School of Economics...
- Health care reformHealth care reformHealth care reform is a general rubric used for discussing major health policy creation or changes—for the most part, governmental policy that affects health care delivery in a given place...
- Health crisisHealth crisisA health crisis or public health crisis is a difficult situation or complex health system that affects humans in one or more geographic areas, from a particular locality to encompass the entire planet...
- Health economicsHealth economicsHealth economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and health care...
- Health human resourcesHealth Human ResourcesHealth human resources — also known as “human resources for health” or “health workforce” — is defined as “all people engaged in actions whose primary intent is to enhance health”, according to the World Health Organization's World Health Report 2006. Human resources for health are identified as...
- Health insuranceHealth insuranceHealth insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
- Health policy
- Health services researchHealth services researchHealth services research is a multidisciplinary scientific field that examines how people get access to health care practitioners and health care services, how much care costs, and what happens to patients as a result of this care...
- National health insuranceNational health insuranceNational health insurance is health insurance that insures a national population for the costs of health care and usually is instituted as a program of healthcare reform. It is enforced by law. It may be administered by the public sector, the private sector, or a combination of both...
- Primary carePrimary carePrimary 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...
- Primary health carePrimary health carePrimary health care, often abbreviated as “PHC”, has been defined as "essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost...
- Public healthPublic healthPublic health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
- Publicly-funded health carePublicly-funded health carePublicly funded health care is a form of health care financing designed to meet the cost of all or most health care needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population...
- Single-payer health careSingle-payer health careSingle-payer health care is medical care funded from a single insurance pool, run by the state. Under a single-payer system, universal health care for an entire population can be financed from a pool to which many parties employees, employers, and the state have contributed...
- Socialized medicineSocialized medicineSocialized medicine is a term used to describe a system for providing medical and hospital care for all at a nominal cost by means of government regulation of health services and subsidies derived from taxation. It is used primarily and usually pejoratively in United States political debates...
- Two-tier health careTwo-tier health careTwo-tier health care is a term used to describe a situation that arises when there is a basic health care system financed by government providing medically necessary but perhaps quite basic health care services, and a secondary tier of care for those with access to more funds who can purchase...
- Universal health careUniversal health careUniversal 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.-History:...
External links
- World Health Organization: Health Systems
- HRC/Eldis Health Systems Resource Guide research and other resources on health systems in developing countries
- OECD: Health policies, a list of latest publications by OECD