Description Table of Contents Author s Bio. Summary Cost-effectiveness analysis is becoming an increasingly important tool for decision making in the health systems. Features Focuses on cost-effectiveness analysis as a statistical decision problem and applies the well-established optimal statistical decision methodology.
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Few Studies Compare the Efficacy of Medical Treatments - Scientific American
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Regional Centers. National Centers. Program Partners. Industry Partners. Get Involved. Your First Name. Legal, credentialing and financing frameworks are established by individual governments, augmented on occasion by international organizations, such as churches. The characteristics of any given health care system have significant impact on the way medical care is provided.
From ancient times, Christian emphasis on practical charity gave rise to the development of systematic nursing and hospitals and the Catholic Church today remains the largest non-government provider of medical services in the world. 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 provide no guarantee of healthcare for the population as a whole. In such societies, healthcare 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. While the US healthcare system has come under fire for lack of openness,  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. Primary care medical services are provided by physicians , physician assistants , nurse practitioners , 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. 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 departments , 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. In low-income countries, modern healthcare is often too expensive for the average person. International healthcare policy researchers have advocated that "user fees" be removed in these areas to ensure access, although even after removal, significant costs and barriers remain. Separation of prescribing and dispensing is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from the pharmacist who provides the prescription drug.
In the Western world there are centuries of tradition for separating pharmacists from physicians. In Asian countries it is traditional for physicians to also provide drugs. Working together as an interdisciplinary team , many highly trained health professionals besides medical practitioners are involved in the delivery of modern health care. Examples include: nurses , emergency medical technicians and paramedics, laboratory scientists, pharmacists , podiatrists , physiotherapists , respiratory therapists , speech therapists , occupational therapists , radiographers, dietitians , and bioengineers , surgeons , surgeon's assistant , surgical technologist.
The scope and sciences underpinning human medicine overlap many other fields. Dentistry , while considered by some a separate discipline from medicine, is a medical field. A patient admitted to the hospital is usually under the care of a specific team based on their main presenting problem, e. Physicians have many specializations and subspecializations into certain branches of medicine, which are listed below.
There are variations from country to country regarding which specialties certain subspecialties are in. In the broadest meaning of "medicine", there are many different specialties. In the UK, most specialities have their own body or college, which have its own entrance examination.
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These are collectively known as the Royal Colleges, although not all currently use the term "Royal". The development of a speciality is often driven by new technology such as the development of effective anaesthetics or ways of working such as emergency departments ; the new specialty leads to the formation of a unifying body of doctors and the prestige of administering their own examination.
Within medical circles, specialities usually fit into one of two broad categories: "Medicine" and "Surgery. At present, some specialties of medicine do not fit easily into either of these categories, such as radiology, pathology, or anesthesia. Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat a pathological condition such as disease or injury , to help improve bodily function or appearance or to repair unwanted ruptured areas for example, a perforated ear drum.
Surgeons must also manage pre-operative, post-operative, and potential surgical candidates on the hospital wards. Surgery has many sub-specialties, including general surgery , ophthalmic surgery , cardiovascular surgery , colorectal surgery , neurosurgery , oral and maxillofacial surgery , oncologic surgery , orthopedic surgery , otolaryngology , plastic surgery , podiatric surgery , transplant surgery , trauma surgery , urology , vascular surgery , and pediatric surgery.
In some centers, anesthesiology is part of the division of surgery for historical and logistical reasons , although it is not a surgical discipline. Other medical specialties may employ surgical procedures, such as ophthalmology and dermatology , but are not considered surgical sub-specialties per se. Surgical training in the U. Sub-specialties of surgery often require seven or more years. In addition, fellowships can last an additional one to three years. Because post-residency fellowships can be competitive, many trainees devote two additional years to research. Thus in some cases surgical training will not finish until more than a decade after medical school.
Furthermore, surgical training can be very difficult and time-consuming. Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases.
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According to some sources, an emphasis on internal structures is implied. Because their patients are often seriously ill or require complex investigations, internists do much of their work in hospitals. Formerly, many internists were not subspecialized; such general physicians would see any complex nonsurgical problem; this style of practice has become much less common.
In modern urban practice, most internists are subspecialists: that is, they generally limit their medical practice to problems of one organ system or to one particular area of medical knowledge. For example, gastroenterologists and nephrologists specialize respectively in diseases of the gut and the kidneys. In the Commonwealth of Nations and some other countries, specialist pediatricians and geriatricians are also described as specialist physicians or internists who have subspecialized by age of patient rather than by organ system.
Elsewhere, especially in North America, general pediatrics is often a form of primary care. There are many subspecialities or subdisciplines of internal medicine :. Training in internal medicine as opposed to surgical training , varies considerably across the world: see the articles on medical education and physician for more details.