Primary health care

Primary health care


Medical train "Therapist Matvei Mudrov" in Khabarovsk, Russia
Primary care is the term for the health care services which play a role in the local community. It refers to the work of health care professionals who act as a first point of consultation for all patients within the health care system.
Such a professional would usually be a primary care physician, such as a general practitioner or family physician, or a non-physician primary care provider, such as a physician assistant or nurse practitioner. Depending on the locality, health system organization, and sometimes at the patient's discretion, they may see another health care professional first, such as a pharmacist, a nurse (such as in the United Kingdom), a clinical officer (such as in parts of Africa), or an Ayurvedic or other traditional medicine professional (such as in parts of Asia). Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.

Primary care involves the widest scope of health care, including all ages of patients, patients of all socioeconomic and geographic origins, patients seeking to maintain optimal health, and patients with all manner of acute and chronic physical, mental and social health issues, including multiple chronic diseases. Consequently, a primary care practitioner must possess a wide breadth of knowledge in many areas. Continuity is a key characteristic of primary care, as patients usually prefer to consult the same practitioner for routine check-ups and preventive care, health education, and every time they require an initial consultation about a new health problem. The International Classification of Primary Care (ICPC) is a standardized tool for understanding and analyzing information on interventions in primary care by the reason for the patient visit.

Common chronic illnesses usually treated in primary care may include, for example: hypertension, diabetes, asthma, COPD, depression and anxiety, back pain, arthritis or thyroid dysfunction. Primary care also includes many basic maternal and child health care services, such as family planning services and vaccinations.
In context of global population aging, with increasing numbers of older adults at greater risk of chronic non-communicable diseases, rapidly increasing demand for primary care services is expected around the world, in both developed and developing countries.

The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary health care strategy.

Secondary health care

Secondary health care

Secondary care is the health care services provided by medical specialists and other health professionals who generally do not have first contact with patients, for example, cardiologists, urologists and dermatologists.

It includes acute care: necessary treatment for a short period of time for a brief but serious illness, injury or other health condition, such as in a hospital emergency department. It also includes skilled attendance during childbirth, intensive care, and medical imaging services.
The "secondary care" is sometimes used synonymously with "hospital care". However many secondary care providers do not necessarily work in hospitals, such as psychiatrists, clinical psychologists, occupational therapists or physiotherapists, and some primary care services are delivered within hospitals. Depending on the organization and policies of the national health system, patients may be required to see a primary care provider for a referral before they can access secondary care.

For example in the United States, which operates under a mixed market health care system, some physicians might voluntarily limit their practice to secondary care by requiring patients to see a primary care provider first, or this restriction may be imposed under the terms of the payment agreements in private/group health insurance plans. In other cases medical specialists may see patients without a referral, and patients may decide whether self-referral is preferred.
In the United Kingdom and Canada, patient self-referral to a medical specialist for secondary care is rare as prior referral from another physician (either a primary care physician or another specialist) is considered necessary, regardless of whether the funding is from private insurance schemes or national health insurance.
Allied health professionals, such as physical therapists, respiratory therapists, occupational therapists, speech therapists, and dietitians, also generally work in secondary care, accessed through either patient self-referral or through physician referral.

Health care financing

Health care financing
Health care system, Health policy, and Universal health care
There are generally five primary methods of funding health care systems:

general taxation to the state, county or municipality
social health insurance
voluntary or private health insurance
out-of-pocket payments
donations to health charities


In most countries, the financing of health care services features a mix of all five models, but the exact distribution varies across countries and over time within countries. In all countries and jurisdictions, there are many topics in the politics and evidence that can influence the decision of a government, private sector business or other group to adopt a specific health policy regarding the financing structure.
For example, social health insurance is where a nation's entire population is eligible for health care coverage, and this coverage and the services provided are regulated. In almost every jurisdiction with a government-funded health care system, a parallel private, and usually for-profit, system is allowed to operate. This is sometimes referred to as two-tier health care or universal health care.

affordable Care Act is Working to Bring Down Health Care Costs

affordable Care Act is Working to Bring Down Health Care Costs


Before the Affordable Care Act passed, the dramatic rise in health care costs put access to health care coverage out of reach for many Americans. With many people no longer able to afford coverage, the cost of uncompensated care in hospitals rose and those costs were passed along to people that could afford coverage. And, at the same time, health care’s share of the nation’s economy was growing rapidly.

Three years later, the Affordable Care Act is working to bring down health care costs.

The law includes innovative tools to drive down health care costs.  It incentivizes efficient care, supports a robust health information technology infrastructure, and fights fraud and waste.   After decades of growing faster than the economy, last year, Medicare costs grew by only four-tenths of a percent per person, continuing the trend of historically low Medicare growth seen in 2011 and 2010.

Major progress in Medicare is sparking smarter care in the private market, and it’s working to bring down costs in the private market. Overall health-care costs grew more slowly than the rest of the economy in 2011 for the first time in more than a decade. And just last week, USA Today  reported health care providers and analysts found that “cost-saving measures under the health care law appear to be keeping medical prices flat.”

Even though the health care law is working to bring down costs, critics continue to claim the law is too expensive.  In reality, the law is fully paid for, and according to the independent Congressional Budget Office, the law reduces the deficit over the long term.  The facts show that employers, patients and our federal budget can’t afford to roll back the law now:

Fully repealing the Affordable Care Act would increase the deficit by $100 billion over ten years and more than a trillion dollars in the next decade.  It would also shorten the life of the Medicare Trust Fund by eight years.
Health care spending grew by 3.9% in 2011, continuing for the third consecutive year the slowest growth rate in fifty years.
Health-care costs grew slower than the rest of the economy in 2011 for the first time in more than a decade.
The proportion of requests for double-digit premium increases plummeted from 75% in 2010 to 14% so far in 2013.
Medicaid spending per beneficiary decreased by 1.9% from 2011 to 2012.
Medicare spending per beneficiary grew by only 0.4% in fiscal year 2012.
Slower growth is projected to reduce Medicare and Medicaid expenditures by 15% or $200 billion by 2020 compared to what those programs would have spent without this slowdown, according to CBO.
At the same time the law is driving down cost growth, the Affordable Care Act is strengthening coverage and expanding coverage.  Thanks to the law, more than 34 million people with Medicare received a no-cost preventive service.  And, over six million Medicare beneficiaries received $5.7 billion in prescription drug discounts.

Some have proposed turning Medicare into a voucher program--undercutting the guaranteed benefits that seniors have earned and forcing them to pay thousands more out of their own pockets.  If we turn Medicare into a voucher program, our system doesn’t have any incentives to be more efficient and lower costs.  Instead, as costs rise, vouchers will leave seniors to pay more and more out of their own pocket.

The health care law is working to lower costs, increase efficiency, and deliver better patient outcomes – without cutting costs at seniors’ expense.  In recent years, we have seen dramatic slowing of the growth of federal health care programs.  The best approach to reducing our deficit is to continue implementing common-sense reforms.  The health care law is putting us on the right path to make Medicare and Medicaid stronger, more efficient and less costly.

affordable Care Act is Working to Bring Down Health Care Costs

affordable Care Act is Working to Bring Down Health Care Costs


Before the Affordable Care Act passed, the dramatic rise in health care costs put access to health care coverage out of reach for many Americans. With many people no longer able to afford coverage, the cost of uncompensated care in hospitals rose and those costs were passed along to people that could afford coverage. And, at the same time, health care’s share of the nation’s economy was growing rapidly.

Three years later, the Affordable Care Act is working to bring down health care costs.

The law includes innovative tools to drive down health care costs.  It incentivizes efficient care, supports a robust health information technology infrastructure, and fights fraud and waste.   After decades of growing faster than the economy, last year, Medicare costs grew by only four-tenths of a percent per person, continuing the trend of historically low Medicare growth seen in 2011 and 2010.

Major progress in Medicare is sparking smarter care in the private market, and it’s working to bring down costs in the private market. Overall health-care costs grew more slowly than the rest of the economy in 2011 for the first time in more than a decade. And just last week, USA Today  reported health care providers and analysts found that “cost-saving measures under the health care law appear to be keeping medical prices flat.”

Even though the health care law is working to bring down costs, critics continue to claim the law is too expensive.  In reality, the law is fully paid for, and according to the independent Congressional Budget Office, the law reduces the deficit over the long term.  The facts show that employers, patients and our federal budget can’t afford to roll back the law now:

Fully repealing the Affordable Care Act would increase the deficit by $100 billion over ten years and more than a trillion dollars in the next decade.  It would also shorten the life of the Medicare Trust Fund by eight years.
Health care spending grew by 3.9% in 2011, continuing for the third consecutive year the slowest growth rate in fifty years.
Health-care costs grew slower than the rest of the economy in 2011 for the first time in more than a decade.
The proportion of requests for double-digit premium increases plummeted from 75% in 2010 to 14% so far in 2013.
Medicaid spending per beneficiary decreased by 1.9% from 2011 to 2012.
Medicare spending per beneficiary grew by only 0.4% in fiscal year 2012.
Slower growth is projected to reduce Medicare and Medicaid expenditures by 15% or $200 billion by 2020 compared to what those programs would have spent without this slowdown, according to CBO.
At the same time the law is driving down cost growth, the Affordable Care Act is strengthening coverage and expanding coverage.  Thanks to the law, more than 34 million people with Medicare received a no-cost preventive service.  And, over six million Medicare beneficiaries received $5.7 billion in prescription drug discounts.

Some have proposed turning Medicare into a voucher program--undercutting the guaranteed benefits that seniors have earned and forcing them to pay thousands more out of their own pockets.  If we turn Medicare into a voucher program, our system doesn’t have any incentives to be more efficient and lower costs.  Instead, as costs rise, vouchers will leave seniors to pay more and more out of their own pocket.

The health care law is working to lower costs, increase efficiency, and deliver better patient outcomes – without cutting costs at seniors’ expense.  In recent years, we have seen dramatic slowing of the growth of federal health care programs.  The best approach to reducing our deficit is to continue implementing common-sense reforms.  The health care law is putting us on the right path to make Medicare and Medicaid stronger, more efficient and less costly.

Shortages of health professionals

Shortages of health professionals
Health workforce, Doctor shortage, and Nursing shortage

Many jurisdictions report shortfalls in the number of trained health human resources to meet population health needs and/or service delivery targets, especially in medically underserved areas. For example, in the United States, the 2010 federal budget invested $330 million to increase the number of doctors, nurses, and dentists practicing in areas of the country experiencing shortages of health professionals. The Budget expands loan repayment programs for physicians, nurses, and dentists who agree to practice in medically underserved areas. This funding will enhance the capacity of nursing schools to increase the number of nurses. It will also allow states to increase access to oral health care through dental workforce development grants. The Budget’s new resources will sustain the expansion of the health care workforce funded in the Recovery Act.
In Canada, the 2011 federal budget announced a Canada Student Loan forgiveness programme to encourage and support new family physicians, nurse practitioners and nurses to practise in underserved rural or remote communities of the country, including communities that provide health services to First Nations and Inuit populations.
In Uganda, the Ministry of Health reports that as many as 50% of staffing positions for health workers in rural and underserved areas remain vacant. As of early 2011, the Ministry was conducting research and costing analyses to determine the most appropriate attraction and retention packages for medical officers, nursing officers, pharmacists, and laboratory technicians in the country’s rural areas.

At the international level, the World Health Organization estimates a shortage of almost 4.3 million doctors, midwives, nurses, and support workers worldwide to meet target coverage levels of essential primary health care interventions.

 The shortage is reported most severe in 57 of the poorest countries, especially in sub-Saharan Africa.

Health care research

The quantity and quality of many health care interventions are improved through the results of science, such as advanced through the medical model of health which focuses on the eradication of illness through diagnosis and effective treatment. Many important advances have been made through health research, including bio medical research and pharmaceutical research. They form the basis of evidence-based medicine and evidence-based practice in health care delivery.

For example, in terms of pharmaceutical research and development spending, Europe spends a little less than the United States (€22.50bn compared to €27.05bn in 2006).

The United States accounts for 80% of the world's research and development spending in biotechnology.

In addition, the results of health services research can lead to greater efficiency and equitable delivery of health care interventions, as advanced through the social model of health and disability, which emphasizes the societal changes that can be made to make population healthier.

 Results from health services research often form the basis of evidence-based policy in health care systems. Health services research is also aided by initiatives in the field of AI for the development of systems of health assessment that are clinically useful, timely, sensitive to change, culturally sensitive, low burden, low cost, involving for the patient and built into standard procedures.