Structures
Contemporary medicine is in general conducted within
health care systems. Legal,
credentialing and financing frameworks are established by
individual governments, augmented on occasion by international
organizations. The characteristics of any given health care
system have significant impact on the way medical care is
provided.
Advanced industrial countries (with the exception of the
United States)
[12][13]
and many developing countries provide medical services though a
system of
universal health care which aims to guarantee care for all
through a
single-payer health care system, or compulsory private or
co-operative
health insurance. This is intended to ensure that the entire
population has access to medical care on the basis of need
rather than ability to pay. Delivery may be via private medical
practices or by state-owned hospitals and clinics, or by
charities; most commonly by a combination of all three.
Most
tribal societies, but also some communist countries (e.g.
China) and the United States,[12][13]
provide no guarantee of health care for the population as a
whole. In such societies, health care is available to those that
can afford to pay for it or have self insured it (either
directly or as part of an employment contract) or who may be
covered by care financed by the government or tribe directly.
Transparency of information is another factor defining a
delivery system. Access to information on conditions,
treatments, quality and pricing greatly affects the choice by
patients / consumers and therefore the incentives of medical
professionals. While the US health care system has come under
fire for lack of openness
[14], new legislation
may encourage greater openness. There is a perceived tension
between the need for transparency on the one hand and such
issues as patient confidentiality and the possible exploitation
of information for commercial gain on the other.
Delivery
Provision of medical care is classified into primary,
secondary and tertiary care categories.
Primary care medical services are provided by physicians or
other health professionals who have first contact with a patient
seeking medical treatment or care. These occur in physician
offices,
clinics,
nursing homes,
schools,
home
visits and other places close to patients. About 90% of medical
visits can be treated by the primary care provider. These
include treatment of acute and chronic illnesses, preventive
care and health education for all ages and both sexes.
Secondary care medical services are provided by
medical specialists in their offices or clinics or at local
community hospitals for a patient referred by a primary care
provider who first diagnosed or treated the patient. Referrals
are made for those patients who required the expertise or
procedures performed by specialists. These include both
ambulatory care and
inpatient services,
emergency rooms,
intensive care medicine,
surgery services,
physical therapy,
labor and delivery,
endoscopy units, diagnostic
laboratory and
medical imaging services,
hospice centers, etc. Some primary care providers may also
take care of hospitalized patients and deliver babies in a
secondary care setting.
Tertiary care medical services are provided by specialist
hospitals or regional centers equipped with diagnostic and
treatment facilities not generally available at local hospitals.
These include
trauma centers,
burn treatment centers, advanced
neonatology unit services,
organ transplants, high-risk
pregnancy,
radiation
oncology, etc.
Modern medical care also depends on information - still
delivered in many health care settings on paper records, but
increasingly nowadays by electronic means.
