Medical education is education related to the practice of being a medical practitioner. Medical education and training varies across the world. Various teaching methodologies have been utilised in medical education, an active area of educational research. Entry-level medical education programs are tertiary-level courses undertaken at a medical school. Depending on jurisdiction and university, these may be either undergraduate-entry, or graduate-entry programs; some jurisdictions and universities provide both undergraduate entry programs and graduate entry programs. In general, initial training is taken at medical school. Traditionally initial medical education is divided between clinical studies; the former consists of the basic sciences such as anatomy, biochemistry, pathology. The latter consists of teaching in the various areas of clinical medicine such as internal medicine, pediatrics and gynecology, general practice and surgery. However, medical programs are using systems-based curricula in which learning is integrated, several institutions do this.
In the United States, until quite the requirements for the M. D. degree did not include one course in human nutrition. Today, this omission has been rectified, at least to the extent. There has been a proliferation of programmes that combine medical training with research or management programmes, although this has been criticised because extended interruption to clinical study has been shown to have a detrimental effect on ultimate clinical knowledge. Following completion of entry-level training, newly graduated doctors are required to undertake a period of supervised practice before full registration is granted. Further training in a particular field of medicine may be undertaken. In the U. S. further specialized training, completed after residency is referred to as "fellowship". In some jurisdictions, this is commenced following completion of entry-level training, while other jurisdictions require junior doctors to undertake generalist training for a number of years before commencing specialisation.
Education theory itself is becoming an integral part of postgraduate medical training. Formal qualifications in education are becoming the norm for medical educators, such that there has been a rapid increase in the number of available graduate programs in medical education. In most countries, continuing medical education courses are required for continued licensing. CME requirements vary by country. In the USA, accreditation is overseen by the Accreditation Council for Continuing Medical Education. Physicians attend dedicated lectures, grand rounds and performance improvement activities in order to fulfill their requirements. Additionally, physicians are opting to pursue further graduate-level training in the formal study of medical education as a pathway for continuing professional development. Medical education is utilizing online teaching within learning management systems or virtual learning environments. Additionally, several medical schools have incorporated the use of blended learning combining the use of video and in-person exercises.
A landmark scoping review published in 2018 demonstrated that online teaching modalities are becoming prevalent in medical education, with associated high student satisfaction and improvement on knowledge tests. However, the use of evidence-based multimedia design principles in the development of online lectures was reported, despite their known effectiveness in medical student contexts. Research areas into online medical education include practical applications, including simulated patients and virtual medical records; when compared to no intervention, simulation in medical education training is associated with positive effects on knowledge and behaviors and moderate effects for patient outcomes. At present, in the United Kingdom, a typical medicine course at university is 5 years or 4 years if the student holds a degree. Among some institutions and for some students, it may be 6 years. All programs culminate in the Bachelor of Surgery degree; this is followed by 2 clinical foundation years afterward, namely F1 and F2, similar to internship training.
Students register with the UK General Medical Council at the end of F1. At the end of F2, they may pursue further years of study; the system in Australia is similar, with registration by the Australian Medical Council. In the US and Canada, a potential medical student must first complete an undergraduate degree in any subject before applying to a graduate medical school to pursue an program. U. S. medical schools are all four-year programs. Some students opt for the research-focused M. D./Ph. D. Dual degree program, completed in 7–10 years. There are certain courses that are pre-requisite for being accepted to medical school, such as general chemistry, organic chemistry, mathematics, English, etc; the specific requirements vary by school. In Australia, there are two path
A bed is a piece of furniture, used as a place to sleep or relax. Most modern beds consist of a soft, cushioned mattress on a bed frame, the mattress resting either on a solid base wood slats, or a sprung base. Many beds include a box spring inner-sprung base, a large mattress-sized box containing wood and springs that provide additional support and suspension for the mattress. Beds are available in many sizes, ranging from infant-sized bassinets and cribs, to small beds for a single person or adult, to large queen and king-size beds designed for two people. While most beds are single mattresses on a fixed frame, there are other varieties, such as the murphy bed, which folds into a wall, the sofa bed, which folds out of a sofa, the bunk bed, which provides two mattresses on two tiers. Temporary beds include the folding camp cot; some beds contain neither a padded mattress nor a bed frame, such as the hammock, considered one of the most comfortable places to rest while swaying side to side. Some beds are made for animals.
Beds may have a headboard for resting against, may have side rails and footboards. "Headboard only" beds may incorporate a "dust ruffle", "bed skirt", or "valance sheet" to hide the bed frame. To support the head, a pillow made of a soft, padded material is placed on the top of the mattress; some form of covering blanket is used to insulate the sleeper bed sheets, a quilt, or a duvet, collectively referred to as bedding. Bedding is the removable non-furniture portion of a bed, which enables these components to be washed or aired out. Early beds were little more than piles of some other natural material. An important change was raising them off the ground, to avoid drafts and pests. 23-5 million years ago, before the advent of humans, apes began creating beds composed of a sleeping platform including a wooden pillow. Bedding dated around to 3600 BC was discovered in South Africa; the bedding consists of sedge and other monocotyledons topped with the leaves of Cryptocarya woodii Engl. Beds found in a preserved northern Scottish village, which were raised boxes made of stone and topped with comfortable fillers, were dated to between 3200 BC and 2200 BC.
The Egyptians had high bedsteads which were ascended by steps, with bolsters or pillows, curtains to hang around. The elite of Egyptian society such as its pharaohs and queens had beds made of wood, sometimes gilded. There was a head-rest as well, semi-cylindrical and made of stone, wood, or metal. Ancient Assyrians and Persians had beds of a similar kind, decorated their furniture with inlays or appliques of metal, mother-of-pearl, ivory; the adjacent image showcases a headrest. Headrests like this were used in life to support the head while sleeping, they are found supporting a mummy's head in the coffin. This headrest was made for the tomb, since the offering prayer has been inscribed on the supporting column, although the prayer may have been added after the death of the owner; the oldest account of a bed is that of Odysseus: a charpoy woven of rope plays a role in the Odyssey. A similar bed can be seen at the St Fagans National History Museum in Wales. Odysseus gives an account of how he crafted the nuptial bed for himself and Penelope, out of an ancient, huge olive tree trunk that used to grow on the spot before the bridal chamber was built.
His detailed description persuades the doubting Penelope that the shipwrecked, aged man is indeed her long-lost husband. Homer mentions the inlaying of the woodwork of beds with gold and ivory; the Greek bed had a wooden frame, with a board at the head and bands of hide laced across, upon which skins were placed. At a period the bedstead was veneered with expensive woods; the pillows and coverings became more costly and beautiful. Folding beds, appear in the famous Ancient Greek vase paintings. Roman mattresses were stuffed with hay, or wool. Feathers were used towards the end of the Republic. Small cushions were sometimes at the back; the bedsteads could only be ascended by the help of steps. They were arranged for two people, had a board or railing at the back, as well as the raised portion at the head; the counterpanes were sometimes costly purple embroidered with figures in gold. The bedsteads themselves were of bronze inlaid with silver, Elagabalus had one of solid silver. In the walls of some houses at Pompeii bed niches are found which were closed by curtains or sliding partitions.
Ancient Romans had various kinds of beds for repose. These included: lectus cubicularis, or chamber bed, for normal sleeping lectus genialis, the marriage bed, it was much decorated, was placed in the atrium opposite the door lectus discubitorius, or table bed, on which they ate—for they ate while lying on their left sides—there being three people to one bed, with the middle place accounted the most honorable position lectus lucubratorius, for studying and a lectus funebris, or emortualis, on which the dead were carried to the pyre The ancient Germans lay on the floor on beds of leaves covered with skins, or in a kind of shallow chest filled with leaves and moss. In the early Middle Ages they laid carpets on the floor or on a bench against the wall, placed upon them mattresses stuffed with f
A medical guideline is a document with the aim of guiding decisions and criteria regarding diagnosis and treatment in specific areas of healthcare. Such documents have been in use for thousands of years during the entire history of medicine. However, in contrast to previous approaches, which were based on tradition or authority, modern medical guidelines are based on an examination of current evidence within the paradigm of evidence-based medicine, they include summarized consensus statements on best practice in healthcare. A healthcare provider is obliged to know the medical guidelines of his or her profession, has to decide whether to follow the recommendations of a guideline for an individual treatment. Modern clinical guidelines identify and evaluate the highest quality evidence and most current data about prevention, prognosis, therapy including dosage of medications, risk/benefit and cost-effectiveness, they define the most important questions related to clinical practice and identify all possible decision options and their outcomes.
Some guidelines contain computation algorithms to be followed. Thus, they integrate the identified decision points and respective courses of action with the clinical judgement and experience of practitioners. Many guidelines place the treatment alternatives into classes to help providers in deciding which treatment to use. Additional objectives of clinical guidelines are to standardize medical care, to raise quality of care, to reduce several kinds of risk and to achieve the best balance between cost and medical parameters such as effectiveness, sensitivity, etc, it has been demonstrated that the use of guidelines by healthcare providers such as hospitals is an effective way of achieving the objectives listed above, although they are not the only ones. Guidelines are produced at national or international levels by medical associations or governmental bodies, such as the United States Agency for Healthcare Research and Quality. Local healthcare providers may produce their own set of guidelines or adapt them from existing top-level guidelines.
Special computer software packages known as guideline execution engines have been developed to facilitate the use of medical guidelines in concert with an electronic medical record system. The Guideline Interchange Format is a computer representation format for clinical guidelines that can be used with such engines; the USA and other countries maintain medical guideline clearinghouses. In the USA, the National Guideline Clearinghouse maintains a catalog of high-quality guidelines published by various health and medical associations. In the United Kingdom, clinical practice guidelines are published by the National Institute for Health and Care Excellence. In The Netherlands, two bodies—the Institute for Healthcare Improvement and College of General Practitioners —have published specialist and primary care guidelines, respectively. In Germany, the German Agency for Quality in Medicine coordinates a national program for disease management guidelines. All these organisations are now members of the Guidelines International Network, an international network of organisations and individuals involved in clinical practice guidelines.
Checklists have been used in medical practice to attempt to ensure that clinical practice guidelines are followed. An example is the Surgical Safety Checklist developed for the World Health Organization by Dr. Atul Gawande. According to a meta-analysis after introduction of the checklist mortality dropped by 23% and all complications by 40%, but further high-quality studies are required to make the meta-analysis more robust. In the UK, a study on the implementation of a checklist for provision of medical care to elderly patients admitting to hospital found that the checklist highlighted limitations with frailty assessment in acute care and motivated teams to review routine practices, but that work is needed to understand whether and how checklists can be embedded in complex multidisciplinary care. Guidelines may lose their clinical relevance as they age and newer research emerges. 20% of strong recommendations when based on opinion rather than trials, from practice guidelines may be retracted.
The New York Times reported in 2004 that some simple clinical practice guidelines are not followed to the extent they might be. It has been found that providing a nurse or other medical assistant with a checklist of recommended procedures can result in the attending physician being reminded in a timely manner regarding procedures that might have been overlooked. Guidelines may have conflict of interest; as such, the quality of guidelines may vary especially for guidelines that are published on-line and have not had to follow methodological reporting standards required by reputable clearinghouses. Guidelines may make recommendations. In response to many of these problems with traditional guidelines, the BMJ created a new series of trustworthy guidelines focused on the most pressing medical issues called BMJ Rapid Recommendations; the American Heart Association Guidelines for the Prevention of Infective Endocarditis The BMJ Rapid Recommendation guideline on transcatheter aortic valve implantation versus surgical aortic valve replacement for aortic stenosis.
Clinical formulation Clinical prediction rule Clinical trial protocol Medical algorithm Treatment Guidelines from The Medical Letter British Columbia Medical Guidelines – In Canada, British Columbia's guidelines and protocol
Academic health science centre
An academic health science centre is defined by the Association of Academic Health Centers as: "an educational institution that includes a medical school and at least one allied health professional school and either owns or is affiliated with a teaching hospital or healthcare system". AHSCs are intended to ensure that medical research breakthroughs lead to direct clinical benefits for patients; the organisational structures that comprise an AHSC can take a variety of forms, ranging from simple partnerships to, less fully integrated organisations with a single management board. There are AHSCs operating in a number of countries including Australia, the Republic of Ireland, the Netherlands, Singapore, the United Kingdom and the United States. In Australia, AHSCs are referred to as Advanced Health Research & Translation Centres. AHSCs in operation in Australia include: Brisbane Diamantina Health Partners Melbourne Academic Centre for Health Monash Partners Academic Health Science Centre South Australian Academic Health Science and Translation Centre Sydney Health Partners Sydney Partnership for Health, Research & Enterprise Western Australian Health Translation Network In Canada, AHSCs are referred to as Academic Healthcare Organizations.
AHSCs in operation in Canada include: Hamilton Health Sciences Health Sciences North Only trauma center in Northern Ontario and the neighbouring province of Manitoba. London Health Sciences Centre McGill University Health Centre The Ottawa Hospital Thunder Bay Regional Health Sciences Centre University Health Network Vancouver Hospital and Health Sciences Centre Winnipeg Health Sciences Centre In 2007 a review of healthcare in London led by Professor Lord Darzi, A Framework for Action, recommended the creation of a number of AHSCs. In October 2007 Imperial College Healthcare became the first AHSC to be established in the UK when the Imperial College London Faculty of Medicine merged with the Hammersmith Hospital and St Mary's NHS trusts. Four more AHSCs have subsequently been established in the UK and one is planned. Funding comes from NHS and work was "in hand to identify the funding" when expressions of interest were solicited; when contracts were signed with NHS in 2013, AHSCs shared among themselves around £60 million of funding.
With a clear purpose and approach of individual AHSCs is a matter for local decision with the contrasting approaches adopted as well as the differences in opinions voiced out by network founders. In recent years, broader academic health science networks have been created attached to original health science centres, although cumulatively providing national coverage; the following AHSCs are in operation in the UK: Cambridge University Health Partners, Cambridge Imperial College Academic Health Science Centre, London King's Health Partners, London Manchester Academic Health Science Centre, Manchester Oxford Academic Health Science Centre, Oxford UCL Partners, London Health Science Scotland AHSCs in operation in the United States include: Albany Medical Center, Albany Medical College, New York Anschutz Medical Campus, University of Colorado School of Medicine, Colorado BJC HealthCare, St. Louis, Missouri Boston Medical Center, Boston University, Massachusetts Cedars-Sinai Medical Center, Los Angeles, California Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Ohio Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, New Hampshire Duke University Medical Center Greenville Health System Clinical University Intermountain Medical Center Johns Hopkins Hospital Loma Linda University Health Massachusetts General Hospital and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School Mayo Clinic, Mayo Clinic College of Medicine and Science Medical University of South Carolina, South Carolina Memorial Medical Center and St. John's Hospital National Academy of Medicine National Institutes of Health New York–Presbyterian Hospital, Columbia University and Cornell University, New York, New York NYU Langone Medical Center, New York University, New York, NY Ohio State University Wexner Medical Center, Ohio State University OSF Saint Francis Medical Center and the Children's Hospital of Illinois Providence Alaska Medical Center Robert Wood Johnson University Hospital, Robert Wood Johnson Medical School Stony Brook University Hospital, Stony Brook University- State University of New York, Stony Brook, NY Temple University Hospital, Temple University, Pennsylvania Texas Medical Center Thomas Jefferson University Hospital, Thomas Jefferson University, Pennsylvania Tufts Medical Center UCLA Health System UC San Diego Health UCSF Medical Center Uniformed Services University, University of Alabama at Birmingham, Alabama University of Chicago Medical Cent
Health care or healthcare is the maintenance or improvement of health via the prevention and treatment of disease, illness and other physical and mental impairments in people. Health care is delivered by health professionals in allied health fields. Physicians and physician associates are a part of these health professionals. Dentistry, nursing, optometry, pharmacy, occupational therapy, physical therapy and other health professions are all part of health care, it includes work done in providing primary care, secondary care, tertiary care, as well as in public health. Access to health care may vary across countries and individuals influenced by social and economic conditions as well as health policies. Health care systems are organizations established to meet the health needs of targeted populations. According to the World Health Organization, a well-functioning health care system requires a financing mechanism, a well-trained and adequately paid workforce, reliable information on which to base decisions and policies, well maintained health facilities to deliver quality medicines and technologies.
An efficient health care system can contribute to a significant part of a country's economy and industrialization. Health care is conventionally regarded as an important determinant in promoting the general physical and mental health and well-being of people around the world. An example of this was the worldwide eradication of smallpox in 1980, declared by the WHO as the first disease in human history to be eliminated by deliberate health care interventions; the delivery of modern health care depends on groups of trained professionals and paraprofessionals coming together as interdisciplinary teams. This includes professionals in medicine, physiotherapy, dentistry and allied health, along with many others such as public health practitioners, community health workers and assistive personnel, who systematically provide personal and population-based preventive and rehabilitative care services. While the definitions of the various types of health care vary depending on the different cultural, political and disciplinary perspectives, there appears to be some consensus that primary care constitutes the first element of a continuing health care process and may include the provision of secondary and tertiary levels of care.
Health care can be defined as either private. Primary care refers to the work of health professionals who act as a first point of consultation for all patients within the health care system; such a professional would be a primary care physician, such as a general practitioner or family physician. Another professional would be a licensed independent practitioner such as a physiotherapist, or a non-physician primary care provider such as a physician assistant or nurse practitioner. Depending on the locality, health system organization the patient may see another health care professional first, such as a pharmacist or nurse. Depending on the nature of the health condition, patients may be referred for secondary or tertiary care. Primary care is used as the term for the health care services that play a role in the local community, it can be provided in different settings, such as Urgent care centers which provide same day appointments or services on a walk-in basis. 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, patients with all types of acute and chronic physical and social health issues, including multiple chronic diseases.
A primary care practitioner must possess a wide breadth of knowledge in many areas. Continuity is a key characteristic of primary care, as patients prefer to consult the same practitioner for routine check-ups and preventive care, health education, every time they require an initial consultation about a new health problem; the International Classification of Primary Care is a standardized tool for understanding and analyzing information on interventions in primary care based on the reason for the patient's visit. Common chronic illnesses treated in primary care may include, for example: hypertension, asthma, COPD, depression and anxiety, back pain, arthritis or thyroid dysfunction. Primary care includes many basic maternal and child health care services, such as family planning services and vaccinations. In the United States, the 2013 National Health Interview Survey found that skin disorders and joint disorders, back problems, disorders of lipid metabolism, upper respiratory tract disease were the most common reasons for accessing a physician.
In the United States, primary care physicians have begun to deliver primary care outside of the managed care system through direct primary care, a subset of the more familiar concierge medicine. Physicians in this model bill patients directly for services, either on a pre-paid monthly, quarterly, or annual basis, or bill for each service in the office. Examples of direct primary care practices include Foundation Health in Colorado and Qliance in Washington. In context of global population aging, with increasing numbers of older adults at greater risk of chronic non-communicable diseases increasing demand for primary care services is expected 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 care includes acute care: nec
The doctor–patient relationship is a central part of health care and the practice of medicine. The doctor–patient relationship forms one of the foundations of contemporary medical ethics. A patient must have confidence in the competence of their physician and must feel that they can confide in him or her. For most physicians, the establishment of good rapport with a patient is important; some medical specialties, such as psychiatry and family medicine, emphasize the physician–patient relationship more than others, such as pathology or radiology, which have little contact with patients. The quality of the patient–physician relationship is important to both parties; the doctor and patient's values and perspectives about disease and time available play a role in building up this relationship. A strong relationship between the doctor and patient will lead to frequent, quality information about the patient's disease and better health care for the patient and their family. Enhancing the accuracy of the diagnosis and increasing the patient's knowledge about the disease all come with a good relationship between the doctor and the patient.
Where such a relationship is poor the physician's ability to make a full assessment is compromised and the patient is more to distrust the diagnosis and proposed treatment, causing decreased compliance to follow the medical advice which results in bad health outcomes. In these circumstances and in cases where there is genuine divergence of medical opinions, a second opinion from another physician may be sought or the patient may choose to go to another physician that they trust more. Additionally, the benefits of any placebo effect are based upon the patient's subjective assessment of the physician's credibility and skills. Michael and Enid Balint together pioneered the study of the physician patient relationship in the UK. Michael Balint's "The Doctor, His Patient and the Illness" outlined several case histories in detail and became a seminal text, their work is continued by the Balint Society, The International Balint Federation and other national Balint societies in other countries. It is one of the most influential works on the topic of doctor-patient relationships.
In addition, a Canadian physician known as Sir William Osler was known as one of the "Big Four" professors at the time that the Johns Hopkins Hospital was first founded. At the Johns Hopkins Hospital, Osler had invented the world's first medical residency system. In terms of efficacy, the doctor–patient relationship seems to have a "small, but statistically significant impact on healthcare outcomes". However, due to a small sample size and a minimally effective test, researchers concluded additional research on this topic is necessary. Recognizing that patients receive the best care when they work in partnership with doctors, the UK General Medical Council issued guidance for patients "What to expect from your doctor" in April 2013; the following aspects of the doctor–patient relationship are the subject of commentary and discussion. The default medical practice for showing respect to patients and their families is for the doctor to be truthful in informing the patient of their health and to be direct in asking for the patient's consent before giving treatment.
In many cultures there has been a shift from paternalism, the view that the "doctor always knows best," to the idea that patients must have a choice in the provision of their care and be given the right to provide informed consent to medical procedures. There can be issues with. Furthermore, there are ethical concerns regarding the use of placebo. Does giving a sugar pill lead to an undermining of trust between doctor and patient? Is deceiving a patient for his or her own good compatible with a respectful and consent-based doctor–patient relationship? These types of questions come up in the healthcare system and the answers to all of these questions are far from clear but should be informed by medical ethics. Shared decision making is the idea that as a patient gives informed consent to treatment, that patient is given an opportunity to choose among the treatment options provided by the physician, responsible for their healthcare; this means the doctor does not recommend what the patient should do, rather the patient's autonomy is respected and they choose what medical treatment they want to have done.
A practice, an alternative to this is for the doctor to make a person's health decisions without considering that person's treatment goals or having that person's input into the decision-making process is grossly unethical and against the idea of personal autonomy and freedom. The spectrum of a physician’s inclusion of a patient into treatment decisions is well represented in Ulrich Beck’s World at Risk. At one end of this spectrum is Beck’s Negotiated Approach to risk communication, in which the communicator maintains an open dialogue with the patient and settles on a compromise on which both patient and physician agree. A majority of physicians employ a variation of this communication model to some degree, as it is only with this technique that a doctor can maintain the open cooperation of his or her patient. At the opposite end of this spectrum is the Technocratic Approach to risk communication, in which the physician exerts authoritarian control over the patient’s treatment and pushes the patient to accept the treatment plan with which they are presented in a paternalistic manner.
This communication model places the physician in a position of omniscience and omnipotence over the patient and leaves little room for patient cont
Health policy can be defined as the "decisions and actions that are undertaken to achieve specific healthcare goals within a society". According to the World Health Organization, an explicit health policy can achieve several things: it defines a vision for the future. There are many categories of health policies, including global health policy, public health policy, mental health policy, health care services policy, insurance policy, personal healthcare policy, pharmaceutical policy, policies related to public health such as vaccination policy, tobacco control policy or breastfeeding promotion policy, they may cover topics of financing and delivery of healthcare, access to care, quality of care, health equity. Health-related policy and its implementation is complex. Conceptual models can help show the flow from health-related policy development to health-related policy and program implementation and to health systems and health outcomes. Policy should be understood as more than a national law or health policy that supports a program or intervention.
Operational policies are the rules, regulations and administrative norms that governments use to translate national laws and policies into programs and services. The policy process encompasses decisions made at a national or decentralized level that affect whether and how services are delivered. Thus, attention must be paid to policies at multiple levels of the health system and over time to ensure sustainable scale-up. A supportive policy environment will facilitate the scale-up of health interventions. 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 policy. Evidence-based policy relies on the use of science and rigorous studies such as randomized controlled trials to identify programs and practices capable of improving policy relevant outcomes. Most political debates surround personal health care policies those that seek to reform healthcare delivery, can be categorized as either philosophical or economic.
Philosophical debates center around questions about individual rights and government authority, while economic topics include how to maximize the efficiency of health care delivery and minimize costs. The modern concept of healthcare involves access to medical professionals from various fields as well as medical technology, such as medications and surgical equipment, it involves access to the latest information and evidence from research, including medical research and health services research. In many countries it is left to the individual to gain access to healthcare goods and services by paying for them directly as out-of-pocket expenses, to private sector players in the medical and pharmaceutical industries to develop research. Planning and production of health human resources is distributed among labour market participants. Other countries have an explicit policy to ensure and support access for all of its citizens, to fund health research, to plan for adequate numbers and quality of health workers to meet healthcare goals.
Many governments around the world have established universal health care, which takes the burden of healthcare expenses off of private businesses or individuals through pooling of financial risk. There are a variety of arguments against universal healthcare and related health policies. Healthcare is an important part of health systems and therefore it accounts for one of the largest areas of spending for both governments and individuals all over the world. Many countries and jurisdictions integrate a human rights philosophy in directing their healthcare policies; the World Health Organization reports that every country in the world is party to at least one human rights treaty that addresses health-related rights, including the right to health as well as other rights that relate to conditions necessary for good health. The United Nations' Universal Declaration of Human Rights asserts that medical care is a right of all people: UDHR Article 25: "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing and medical care and necessary social services, the right to security in the event of unemployment, disability, old age or other lack of livelihood in circumstances beyond his control."In some jurisdictions and among different faith-based organizations, health policies are influenced by the perceived obligation shaped by religious beliefs to care for those in less favorable circumstances, including the sick.
Other jurisdictions and non-governmental organizations draw on the principles of humanism in defining their health policies, asserting the same perceived obligation and enshrined right to health. In recent years, the worldwide human rights organization Amnesty International has focused on health as a human right, addressing inadequate access to HIV drugs and women's sexual and reproductive rights including wide disparities in maternal mortality within and across countries; such increasing attention to health as a basic human right has been welcomed by the leading medical journal The Lancet. There remains considerable controversy regarding policies on who would be paying the costs of medical care for all people and under what circumstances. For example, government spending on healthcare is sometimes used as a global indicator of a government's commitment to the health of its people. On the other hand, one school of thought emerging from the United States rejects the notion of health care financing through taxpayer funding as incompatible with the