Healthcare Series

So, What is Healthcare? Part 2: Public Health and Healthcare Tiers

The second edition of “So What is Healthcare?” series will focus on public health and the organization of medical care.

The goal of this post series is to educate and outline the healthcare system and the current debates surrounding accessibility to healthcare and health insurance. While I am not an expert in this field, I will hyperlink reliable sources that can offer further information about the topics at hand. Please leave your political stances, charged/accusatory/emotional comments, or closed mind at the entry to the site and approach these topics with an understanding that health care will never be a topic of uniform opinion. Regardless of the direction our country takes in regards to it’s own healthcare system in the next few years, there will always be some who are dissatisfied with the changes, and there will always be people with opinions different from your own. Here, I hope to shed light on the basics of the healthcare system with the goal of forming a ground of mutual understanding. Not everyone has to agree, but we should all be well informed.

The United States has undertaken several campaigns and public health goals since its inception. There is a notable list of accomplishments of public health that accounts for the top 10 of these endeavors. You may be surprised to note that most of these accomplishments are concepts included in our education, media, and often a part of political campaigns. The reason here is simple: a simple change can affect a great number of people, making these goals cost effective and a matter of public interest. The CDC lists these accomplishments on their website. The are:

1. Immunizations

2. Motor Vehicle Safety (aka Seat belts)

3. Workplace Safety

4.Control of Infectious Diseases

5. Reduction in Heart Disease and Strokes

6. Food Safety

7. Improvement in Maternal and Baby Health

8. Family Planning

9. Fluoridated Drinking Water

10. Recognition of Tobacco as a Health Hazard

Public health generally applies to populations of people, although the campaigns and implementation of the projects may affect individuals. The programs are often preventative in nature and are aimed at improving the health of many, with a lasting impact over time. On the other hand, the practice of caring for individuals and a reactive care model are the basis of our health care system, which is when we go to a doctor or a specialist for illness or chronic condition management.

The healthcare system can be divided into 3 subdivisions based on the level and type of care provided. The function of each level and the type of patients seen at each level further differentiate these care levels and create a more organized healthcare system. These levels are primary care, secondary care, and tertiary care

Primary care: This level of care consists of what most of us think of as our “regular doctor.” Primary care physicians include pediatrics, family medicine, internal medicine, and occasionally obstetricians/gynecologists. These specialists’ scope of practice focuses on the main health problems in the community. Their clinics are often located within the community they serve. They are often the medical care level that has an interest in promoting health, preventative care, and is the basis of many referrals to other specialists or healthcare providers. These specialists have an interest in promoting healthy diet and exercise, good sleep practices, and family planning. This area of care is also largely where the clinical implementation of public health efforts take place. This includes immunizations, education, and other elements of basic care. As opposed to other specialist positions, these physicians see a diverse range of conditions not limited by problem origin, organ system, or diagnosis.

Primary care is the point of first patient contact and is often the central locus of their care plan. Many patients see their primary care provider (PCP) for a new, undiagnosed condition or for continuing care for unresolved diagnoses. This physician is also usually responsible for providing continuity of care. They play an important role in ensuring that medical care is coordinated between all the providers involved and is dealt with on any long term basis, if needed. It is also important to note that your PCP should be your first choice of care for any symptom or condition that is not emergent.

Now is a good time to take a break in order to outline the difference between emergent and non-emergent states. Emergent care is designed to treat medical emergencies. This includes threats to life, limb, or eyesight. These are the emergencies we think about when we see an ambulance drive by or when we watch NCIS. Gun shot wounds, car crashes, profuse bleeding, appendicitis, drug overdoses, etc. These are things that cannot wait for treatment and can be life threatening without medical intervention. Urgent conditions are states that require care within a timely manner due to discomfort or possible worsening. These are, of course, great candidates for urgent care centers or stand alone clinics which are able to see patients with conditions not warranted for the ER, but still in need of medical care. Some PCPs are able to see patients the very same day, allowing for their office to also be a place of urgent treatment. Routine care is the condition most suited for primary care offices because they are long standing, stable conditions or illnesses that may resolve on their own (common cold, ear infection, etc).While this may sound like a simple differentiation, it is important to know that miss-attribution of a condition as an emergency when it is not one can end up costing time, resources and money for both yourself, the medical facility, and others in need of emergency services.

Secondary care: Medical care provided by specialists who have specialized medical training focused on specific organs and diseases is secondary care. These providers offer care through referrals from primary care physicians and often treat a patient base spread over a larger land area. While primary care physicians are located in each community, secondary providers service the district and county levels. They include cardiologists, gastroenterologists, oncologists, endocrinologists, etc. For many people, these specialists are located in offices in hospitals or health clinics.

Tertiary care:This is medical care given by providers in a specialized medical facility, often provided by subspecialists and sub-subspecialists. These physicians use advanced, complex procedures and treatments with state-of-the-art technology, tools, and facilities. They also see patients on referrals from primary and secondary care providers. This can include pediatric subspecialties such as pediatric oncology, pediatric neurology, pediatric cardiology, etc.

The basis of the healthcare system is its medical structure. The division of pulic healthcare from medical healthcare creates a dual system for addressing the needs of the people. The medical system is further divided into 3 tiers: primary, secondary and tertiary care. How this system is utilized by patients can be affected by the rules and regulations surrounding the system, as well as the financial attributes of the government and insurance agencies. These topics will be covered in later posts.

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