The healthcare industry over the past decade has observed revolutionary changes. Technology along with human expertise has completely changed the process of prevention, diagnosis, and treatment of diseases at almost every level of the healthcare delivery system.
The health system or healthcare delivery system consists of a broad spectrum of activities and people comprising patients, families, communities, populations, and organizations along with the policies, regulations, promotions, and laws that have a direct and indirect impact on patient care. The healthcare delivery system is designed to provide a safe, accessible, cost-effective, and quality health services to patients.
Worldwide, countries follow different healthcare delivery systems to fulfill the health needs of its citizens. The delivery system or structure varies according to the needs and resources of the country. In some countries, there is a heavy presence of private players while in some countries the healthcare system is more reliant on government resources. The healthcare system can be divided into different levels depending on the complexity of the medical cases/condition, skills, and specialties of the services providers and the equipment. The various levels of health delivery system depending upon the skill and expertise of the service providers include:
Primary health care is the first level of the healthcare delivery system. It is the initial point of contact for individuals and families with healthcare providers such as general practitioners, nurses, and physicians. The health care services here more or less are for medical conditions such as common cold, bacterial and viral disease, flu, or other diseases. It also includes services for acute medical problems such as broken bone, sore muscles or acute body pain.
The secondary care treats most of the conditions which are often referred from primary health care. It consists of specialists in higher hospitals who have expertise in treating specific conditions or diseases. Secondary care provides treatment for diseases such as cancer, diabetes or thyroid disease, etc. Secondary healthcare is often referred to as Community Health Care Centres in some countries.
Specialist Hospitals, Regional centers, and Central institutes provide Tertiary Care upon referral from primary and secondary medical care. These centers provide specialized consultative services for complex disease/conditions through specialized expertise and equipment (such as advanced diagnostic support services and Intensive Care Units). The tertiary healthcare provides solutions to medical conditions such as neurosurgery, coronary artery bypass surgery, plastic surgery, renal or hemodialysis, and many others.
Quaternary care is often referred to as an extension of tertiary care, provides the most advanced levels of solution for particular medical conditions or systems of the body. Quaternary Care involves experimental medicine, diagnostics, and surgical procedures, which are not widely accessed.
Primary health care (PHC) plays a critical role in any country’s healthcare system. PHC fulfills the majority of health needs that a person requires throughout his lifetime. The WHO worldwide is playing a crucial role in promoting universal health coverage by providing solutions for effective healthcare delivery systems. In order to attain the goal of ‘Health for All’, the WHO adopted the Alma-Ata Declaration on Primary Health Care (PHC) in 1978. PHC focuses on the health services at the primary care level and also addresses the underlying social, economic, and political causes of poor health in the healthcare model. Alma-Ata Declaration outlined essential elements for PHC such as :
- Addressing the main health problems in the community, providing promotive, preventive, curative and rehabilitative services.
- Education concerning prevailing health problems and the methods of preventing and controlling them.
- Promotion of food supply and proper nutrition
- Supply of safe water and basic sanitation
- Maternal and child health care
- Prevention and control of locally endemic diseases
- Appropriate treatment of common diseases and injuries; and provision of essential drugs
However, there are certain challenges and issues in the implementation of PHC such as the search for a standard implementation protocol and evaluation of healthcare interventions.
The healthcare delivery system faces many challenges and issues. As per the WHO, around 50% of all the people still lack some or all essential health services. There will be a shortfall of around 18 Million healthcare workers by 2030. The shortage of physicians and supportive human resources is a big challenge for the healthcare delivery system. It is one of the most primary issues for any healthcare system.
The chronic and epidemic diseases are another major challenge. The incidence and prevalence of chronic diseases are on a continuous rise and have a direct impact on the healthcare resources of a country. Similarly, the high cost of drugs and healthcare services, medical errors, and unethical practice are some other issues that impact the patient’s quality of life and experience with the healthcare system.
Albeit challenges, the healthcare delivery system during the past decades has observed many revolutionary changes and is expected to do so in the coming years. Technology is one of the key elements set to transform the health delivery system. For instance, Wearable devices are making a direct impact on disease management and patient health. With the help of these devices, the healthcare provider can easily monitor their patient’s health outside of hospital/clinic settings. Telehealth and telemedicine services through remote patient care are expected to overcome the shortage of doctors and nurses in remote areas and communities. The patients can easily interact with physicians or specialists through virtual health services while sitting miles away from hospitals or clinics. These services save time as well as the medical costs for the patients. Similarly the increased participation of insurance companies, shifts to Value-Based Care, research in medicine & genomics, Iot in healthcare are expected to provide a convenient, affordable, and effective healthcare outcome for the patients in the coming years.