Health

Health care administrators have wide-ranging influence within the world of medicine. The leadership that these professionals provide sets the future course not only for the facilities they manage but also for the health care system as a whole.

Managing a health care facility today is the close equivalent to managing an entire city. It’s a dynamic environment of specialized groups that have both direct and indirect relationships with one another, and at times, competing interests. To lead such an organization requires careful budgeting, tough decision-making, and above all else, the ability to maintain the respect and cooperation of diverse interest groups that are sometimes adversely affected by an administrator’s decisions. 

Within this environment, a health care administrator is responsible for establishing health care standards, making strategic policy decisions and implementing the personnel management procedures necessary to support his vision. In addition to the internal leadership they provide, health care administrators are leaders within the greater community as well. They partner with other health care organizations, comply with government regulations, advocate and testify on behalf of health care policies, and maintain campuses that are significant to communities.

Although the professional titles of health care administrators vary according to their place of employment, the significance of the work they accomplish—and the interdisciplinary skillset required to do so—is universal. Healthcare administrators have the challenge and opportunity to deliver high quality health care within an appealing work environment while contributing positively to the greater community at large. There are few positions within the health care arena as exciting, versatile and rewarding as that of the health care administrator—who has the opportunity to lead, inspire and enact policies of far-reaching consequence. 

About 40 percent of health care administrators work within hospitals. Other employment settings include physicians’ offices, small or large group medical practices, long-term nursing care facilities, home health care agencies, and outpatient clinics or centers. Within these settings, they manage whole facilities or a specific department. Most health care administrators work full-time business hours, but those responsible for 24-hour facilities should expect to work on an urgent or emergent basis during off hours including weekends, nights or holidays.

Education

A bachelor’s degree (four years) is the typical entry-level preparation needed for health care administration jobs. Some employers, however, will promote from within or hire other professionals with related experience (such as nurses) who are ideal for an administrative role because of their direct health care knowledge. For high-level executive positions, a graduate education (two to three years) is usually the starting point. This means attaining a MBA, or a different type of master’s degree, or a doctorate in health administration. Subspecialties are often available, especially in graduate programs. These include long-term care administration, health care services, or health information management. Prospective health care administrators should look for educational programs accredited by the Commission on Accreditation of Healthcare Management Education. An accredited program has successfully gone through a process that ensures accountability and a commitment to quality improvement.

Some educational programs, especially graduate programs in health care administration, have real-world internships as part of the curriculum. Students often spend time in an ancillary or assistant role under the mentorship of a health administrator, or participate in a special project designed to benefit a facility or health care practice. When starting out on the job, health care administrators are trained by either the outgoing employee or directed by a higher-level executive in the organization. Because of their managerial role, however, health care administrators are expected to be independent in their job fairly quickly.

Licensing and/or Certification

In most areas of health care administration, a license is not needed. One notable exception is for administrators of long-term care nursing facilities and some assisted living facilities. State license requirements vary state to state, but a licensing examination, proof of a bachelor’s degree, and successful completion of a training program are typical elements of the licensing process.

Certification is mostly an optional process, depending on a health care administrator’s role and professional goals. Certification is offered by professional associations such as the American College of Health Care Administrators (for long-term care/assisted living professionals) and the Professional Association of Health Care Office Management (for medical practice managers).

Necessary Skills and Qualities

Change is always in the air when it comes to the provision of health care. Healthcare administrators must be adept at adjusting to new developments in health care law, technology and policies. They need to be flexible, creative, analytical and organized in putting policy changes into practice. Healthcare administrators must be able to effectively communicate with people at all professional levels, specialties and roles. Part of doing this well is keeping abreast of what goes on in their department or facility, and knowing details of all employees’ daily responsibilities. Because they are leaders and often operate as the “face” of their organization, health care administrators must always maintain professionalism in demeanor and appearance.

Opportunities for Advancement

Healthcare administrators usually choose to move up the executive ladder. For instance, a manager of a department may become an executive in charge of multiple departments or an entire facility. If a health care administrator doesn't already have it, a graduate education is sometimes necessary for this kind of advancement. Experienced health care administrative professionals are also ideal for taking on consultant roles, becoming educators, or becoming policy makers in a public service or government capacity.

If you would like to gain the necessary education to become a health care administrator, we highly recommend that you check out our free School Finder Tool located HERE.

Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses, among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity. According to the Health Insurance Association of America, health insurance is defined as "coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment"

Background

A health insurance policy is:

A contract between an insurance provider (e.g. an insurance company or a government) and an individual or his/her sponsor (e.g. an employer or a community organization). The contract can be renewable (e.g. annually, monthly) or lifelong in the case of private insurance, or be mandatory for all citizens in the case of national plans. The type and amount of health care costs that will be covered by the health insurance provider are specified in writing, in a member contract or "Evidence of Coverage" booklet for private insurance, or in a national health policy for public insurance.

Provided by an employer-sponsored self-funded ERISA plan. The company generally advertises that they have one of the big insurance companies. However, in an ERISA case, that insurance company "doesn't engage in the act of insurance", they just administer it. Therefore, ERISA plans are not subject to state laws. ERISA plans are governed by federal law under the jurisdiction of the US Department of Labor (USDOL). The specific benefits or coverage details are found in the Summary Plan Description (SPD). An appeal must go through the insurance company, then to the Employer's Plan Fiduciary. If still required, the Fiduciary's decision can be brought to the USDOL to review for ERISA compliance, and then file a lawsuit in federal court.

The individual insured person's obligations may take several forms:[2]

Premium: The amount the policy-holder or their sponsor (e.g. an employer) pays to the health plan to purchase health coverage.

Deductible: The amount that the insured must pay out-of-pocket before the health insurer pays its share. For example, policy-holders might have to pay a $500 deductible per year, before any of their health care is covered by the health insurer. It may take several doctor's visits or prescription refills before the insured person reaches the deductible and the insurance company starts to pay for care. Furthermore, most policies do not apply co-pays for doctor's visits or prescriptions against your deductible.

Co-payment: The amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 co-payment for a doctor's visit, or to obtain a prescription. A co-payment must be paid each time a particular service is obtained.

Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a co-payment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain.

Exclusions: Not all services are covered. The insured are generally expected to pay the full cost of non-covered services out of their own pockets.

Coverage limits: Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some insurance company schemes have annual or lifetime coverage maxima. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.

Out-of-pocket maxima: Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and health insurance pays all further covered costs. Out-of-pocket maxima can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.

Capitation: An amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer.

In-Network Provider: (U.S. term) A health care provider on a list of providers preselected by the insurer. The insurer will offer discounted coinsurance or co-payments, or additional benefits, to a plan member to see an in-network provider. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the "usual and customary" charges the insurer pays to out-of-network providers.

Prior Authorization: A certification or authorization that an insurer provides prior to medical service occurring. Obtaining an authorization means that the insurer is obligated to pay for the service, assuming it matches what was authorized. Many smaller, routine services do not require authorization.[3]

Explanation of Benefits: A document that may be sent by an insurer to a patient explaining what was covered for a medical service, and how payment amount and patient responsibility amount were determined.[3]

Prescription drug plans are a form of insurance offered through some health insurance plans. In the U.S., the patient usually pays a copayment and the prescription drug insurance part or all of the balance for drugs covered in the formulary of the plan. Such plans are routinely part of national health insurance programs. For example in the province of Quebec, Canada, prescription drug insurance is universally required as part of the public health insurance plan, but may be purchased and administered either through private or group plans, or through the public plan.[4]

Some, if not most, health care providers in the United States will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay. The insurance company pays out of network providers according to "reasonable and customary" charges, which may be less than the provider's usual fee. The provider may also have a separate contract with the insurer to accept what amounts to a discounted rate or capitation to the provider's standard charges. It generally costs the patient less to use an in-network provider.

Comparison

See also: Health system

Health Expenditure per capita (in PPP-adjusted US$) among several OECD member nations. Data source: OECD's iLibrary[5]

The Commonwealth Fund, in its annual survey, "Mirror, Mirror on the Wall", compares the performance of the health care systems in Australia, New Zealand, the United Kingdom, Germany, Canada and the U.S. Its 2007 study found that, although the U.S. system is the most expensive, it consistently under-performs compared to the other countries.[6] One difference between the U.S. and the other countries in the study is that the U.S. is the only country without universal health insurance coverage.

Life Expectancy of the total population at birth from 2000 until 2011 among several OECD member nations. Data source: OECD's iLibrary[7]

The Commonwealth Fund completed its thirteenth annual health policy survey in 2010.[8] A study of the survey "found significant differences in access, cost burdens, and problems with health insurance that are associated with insurance design".[8] Of the countries surveyed, the results indicated that people in the United States had more out-of-pocket expenses, more disputes with insurance companies than other countries, and more insurance payments denied; paperwork was also higher although Germany had similarly high levels of paperwork.[8]

Australia

Main article: Health care in Australia

The public health system is called Medicare. It ensures free universal access to hospital treatment and subsidised out-of-hospital medical treatment. It is funded by a 1.5% tax levy on all taxpayers, an extra 1% levy on high income earners, as well as general revenue.

The private health system is funded by a number of private health insurance organizations. The largest of these is Medibank Private, which is government-owned, but operates as a government business enterprise under the same regulatory regime as all other registered private health funds. The Coalition Howard government had announced that Medibank would be privatized if it won the 2007 election, however they were defeated by the Australian Labor Party under Kevin Rudd which had already pledged that it would remain in government ownership.

Some private health insurers are 'for profit' enterprises such as Australian Unity, and some are non-profit organizations such as HCF and the HBF Health Fund (HBF). Some have membership restricted to particular groups, but the majority have open membership. Membership to most health funds is now also available through comparison websites like moneytime, Comparethemarket.com, iSelect, Choosi and YouCompare. These comparison sites operate on a commission-basis by agreement with their participating health funds. The Private Health Insurance Ombudsman also operates a free website which allows consumers to search for and compare private health insurers' products, which includes information on price and level of cover.[9]

Most aspects of private health insurance in Australia are regulated by the Private Health Insurance Act 2007. Complaints and reporting of the private health industry is carried out by an independent government agency, the Private Health Insurance Ombudsman. The ombudsman publishes an annual report that outlines the number and nature of complaints per health fund compared to their market share [10]

The private health system in Australia operates on a "community rating" basis, whereby premiums do not vary solely because of a person's previous medical history, current state of health, or (generally speaking) their age (but see Lifetime Health Cover below). Balancing this are waiting periods, in particular for pre-existing conditions (usually referred to within the industry as PEA, which stands for "pre-existing ailment"). Funds are entitled to impose a waiting period of up to 12 months on benefits for any medical condition the signs and symptoms of which existed during the six months ending on the day the person first took out insurance. They are also entitled to impose a 12-month waiting period for benefits for treatment relating to an obstetric condition, and a 2-month waiting period for all other benefits when a person first takes out private insurance. Funds have the discretion to reduce or remove such waiting periods in individual cases. They are also free not to impose them to begin with, but this would place such a fund at risk of "adverse selection", attracting a disproportionate number of members from other funds, or from the pool of intending members who might otherwise have joined other funds. It would also attract people with existing medical conditions, who might not otherwise have taken out insurance at all because of the denial of benefits for 12 months due to the PEA Rule. The benefits paid out for these conditions would create pressure on premiums for all the fund's members, causing some to drop their membership, which would lead to further rises in premiums, and a vicious cycle of higher premiums-leaving members would ensue.

The Australian government has introduced a number of incentives to encourage adults to take out private hospital insurance. These include:

Lifetime Health Cover: If a person has not taken out private hospital cover by 1 July after their 31st birthday, then when (and if) they do so after this time, their premiums must include a loading of 2% per annum for each year they were without hospital cover. Thus, a person taking out private cover for the first time at age 40 will pay a 20 percent loading. The loading is removed after 10 years of continuous hospital cover. The loading applies only to premiums for hospital cover, not to ancillary (extras) cover.

Medicare Levy Surcharge: People whose taxable income is greater than a specified amount (in the 2011/12 financial year $80,000 for singles and $168,000 for couples[11]) and who do not have an adequate level of private hospital cover must pay a 1% surcharge on top of the standard 1.5% Medicare Levy. The rationale is that if the people in this income group are forced to pay more money one way or another, most would choose to purchase hospital insurance with it, with the possibility of a benefit in the event that they need private hospital treatment – rather than pay it in the form of extra tax as well as having to meet their own private hospital costs.

The Australian government announced in May 2008 that it proposes to increase the thresholds, to $100,000 for singles and $150,000 for families. These changes require legislative approval. A bill to change the law has been introduced but was not passed by the Senate.[12] An amended version was passed on 16 October 2008. There have been criticisms that the changes will cause many people to drop their private health insurance, causing a further burden on the public hospital system, and a rise in premiums for those who stay with the private system. Other commentators believe the effect will be minimal.[13]

Private Health Insurance Rebate: The government subsidises the premiums for all private health insurance cover, including hospital and ancillary (extras), by 10%, 20% or 30%, depending on age. The Rudd Government announced in May 2009 that as of July 2010, the Rebate would become means-tested, and offered on a sliding scale. While this move (which would have required legislation) was defeated in the Senate at the time, in early 2011 the Gillard Government announced plans to reintroduce the legislation after the Opposition loses the balance of power in the Senate. The ALP and Greens (which currently combine in Australia to form a minority government) have long been against the rebate, referring to it as "middle-class welfare".[14]

Canada

Main article: Health care in Canada

Health care is mainly a constitutional, provincial government responsibility in Canada (the main exceptions being federal government responsibility for services provided to aboriginal peoples covered by treaties, the Royal Canadian Mounted Police, the armed forces, and members of parliament). Consequently, each province administers its own health insurance program. The federal government influences health insurance by virtue of its fiscal powers – it transfers cash and tax points to the provinces to help cover the costs of the universal health insurance programs. Under the Canada Health Act, the federal government mandates and enforces the requirement that all people have free access to what are termed "medically necessary services," defined primarily as care delivered by physicians or in hospitals, and the nursing component of long term residential care. If provinces allow doctors or institutions to charge patients for medically necessary services, the federal government reduces its payments to the provinces by the amount of the prohibited charges. Collectively, the public provincial health insurance systems in Canada are frequently referred to as Medicare. This public insurance is tax-funded out of general government revenues, although British Columbia and Ontario levy a mandatory premium with flat rates for individuals and families to generate additional revenues – in essence a surtax. Private health insurance is allowed, but in six provincial governments only for services that the public health plans do not cover, for example, semi-private or private rooms in hospitals and prescription drug plans. Four provinces allow insurance for services also mandated by the Canada Health Act, but in practice there is no market for it. All Canadians are free to use private insurance for elective medical services such as laser vision correction surgery, cosmetic surgery, and other non-basic medical procedures. Some 65% of Canadians have some form of supplementary private health insurance; many of them receive it through their employers.[15] Private-sector services not paid for by the government account for nearly 30 percent of total health care spending.[16]

In 2005, the Supreme Court of Canada ruled, in Chaoulli v. Quebec, that the province's prohibition on private insurance for health care already insured by the provincial plan violated the Quebec Charter of Rights and Freedoms, and in particular the sections dealing with the right to life and security, if there were unacceptably long wait times for treatment, as was alleged in this case. The ruling has not changed the overall pattern of health insurance across Canada but has spurred on attempts to tackle the core issues of supply and demand and the impact of wait times.[17]

China

Main articles: Healthcare reform in the People's Republic of China and Pharmaceutical industry in the People's Republic of China

France

Main article: Health care in France

The national system of health insurance was instituted in 1945, just after the end of the Second World War. It was a compromise between Gaullist and Communist representatives in the French parliament. The Conservative Gaullists were opposed to a state-run healthcare system, while the Communists were supportive of a complete nationalisation of health care along a British Beveridge model.

The resulting programme is profession-based: all people working are required to pay a portion of their income to a not-for-profit health insurance fund, which mutualises the risk of illness, and which reimburses medical expenses at varying rates. Children and spouses of insured people are eligible for benefits, as well. Each fund is free to manage its own budget, and used to reimburse medical expenses at the rate it saw fit, however following a number of reforms in recent years, the majority of funds provide the same level of reimbursement and benefits.

The government has two responsibilities in this system.

The first government responsibility is the fixing of the rate at which medical expenses should be negotiated, and it does so in two ways: The Ministry of Health directly negotiates prices of medicine with the manufacturers, based on the average price of sale observed in neighboring countries. A board of doctors and experts decides if the medicine provides a valuable enough medical benefit to be reimbursed (note that most medicine is reimbursed, including homeopathy). In parallel, the government fixes the reimbursement rate for medical services: this means that a doctor is free to charge the fee that he wishes for a consultation or an examination, but the social security system will only reimburse it at a pre-set rate. These tariffs are set annually through negotiation with doctors' representative organisations.

The second government responsibility is oversight of the health-insurance funds, to ensure that they are correctly managing the sums they receive, and to ensure oversight of the public hospital network.

Today, this system is more or less intact. All citizens and legal foreign residents of France are covered by one of these mandatory programs, which continue to be funded by worker participation. However, since 1945, a number of major changes have been introduced. Firstly, the different health-care funds (there are five: General, Independent, Agricultural, Student, Public Servants) now all reimburse at the same rate. Secondly, since 2000, the government now provides health care to those who are not covered by a mandatory regime (those who have never worked and who are not students, meaning the very rich or the very poor). This regime, unlike the worker-financed ones, is financed via general taxation and reimburses at a higher rate than the profession-based system for those who cannot afford to make up the difference. Finally, to counter the rise in health-care costs, the government has installed two plans, (in 2004 and 2006), which require insured people to declare a referring doctor in order to be fully reimbursed for specialist visits, and which installed a mandatory co-pay of 1 € (about $1.45) for a doctor visit, 0,50 € (about 80¢) for each box of medicine prescribed, and a fee of 16–18 € ($20–25) per day for hospital stays and for expensive procedures.

An important element of the French insurance system is solidarity: the more ill a person becomes, the less the person pays. This means that for people with serious or chronic illnesses, the insurance system reimburses them 100% of expenses, and waives their co-pay charges.

Finally, for fees that the mandatory system does not cover, there is a large range of private complementary insurance plans available. The market for these programs is very competitive, and often subsidised by the employer, which means that premiums are usually modest. 85% of French people benefit from complementary private health insurance.[18][19]

Germany

Main article: Healthcare in Germany

Germany has the world's oldest national social health insurance system,[20] with origins dating back to Otto von Bismarck's Sickness Insurance Law of 1883.[21][22]

Currently 85% of the population is covered by a basic health insurance plan provided by statute, which provides a standard level of coverage. The remainder opt for private health insurance[citation needed], which frequently offers additional benefits. According to the World Health Organization, Germany's health care system was 77% government-funded and 23% privately funded as of 2004.[23]

The government partially reimburses the costs for low-wage workers, whose premiums are capped at a predetermined value. Higher wage workers pay a premium based on their salary. They may also opt for private insurance, which is generally more expensive, but whose price may vary based on the individual's health status.[24]

Reimbursement is on a fee-for-service basis, but the number of physicians allowed to accept Statutory Health Insurance in a given locale is regulated by the government and professional societies.

Co payments were introduced in the 1980s in an attempt to prevent over utilization. The average length of hospital stay in Germany has decreased in recent years from 14 days to 9 days, still considerably longer than average stays in the United States (5 to 6 days).[25][26] Part of the difference is that the chief consideration for hospital reimbursement is the number of hospital days as opposed to procedures or diagnosis. Drug costs have increased substantially, rising nearly 60% from 1991 through 2005. Despite attempts to contain costs, overall health care expenditures rose to 10.7% of GDP in 2005, comparable to other western European nations, but substantially less than that spent in the U.S. (nearly 16% of GDP).[27]

Insurance systems

Germans are offered three kinds of social security insurance dealing with the physical status of a person and which are co-financed by employer and employee: health insurance, accident insurance, and long-term care insurance.

Germany has a universal multi-payer system with two main types of health insurance: law enforced health insurance (or public health insurance) (Gesetzliche Krankenversicherung (GKV)) and private insurance (Private Krankenversicherung (PKV)). Both systems struggle with the increasing cost of medical treatment and the changing demography. About 87.5% of the persons with health insurance are members of the public system, while 12.5% are covered by private insurance (as of 2006).[28] There are many differences between the public health insurance and private insurance. In general the benefits and costs in the private insurance are better for young people without family. There are hard salary requirements to join the private insurance because it´s getting more expensive advanced in years.[29]

Statutory health insurance/Gesetzliche Krankenversicherung (GKV)[edit]

The statutory health insurance (est. in 1883) is part of the German social insurance system, together with the statutory accident insurance (est. 1883), the statutory old age and disability insurance (est. in 1889), the unemployment insurance (est. in 1927) and the long term care insurance (est. in 1995).[citation needed]

Since 2009, health insurance is mandatory for anyone living in Germany.[citation needed]

The statutory health insurance is a compulsory insurance for employees with a yearly income below €50,850 (in 2012, adjusted annually) and others.[citation needed]

History

With the 'Imperial Bill of 15 June 1883' and its update from 10 April 1892 the health insurance bill was created, which introduced compulsory health insurance for workers. Austria followed Germany in 1888, Hungary in 1891 and Switzerland in 1911.

On 29 April 1869 the county health insurance ill[clarification needed] in Bavaria created the first law that introduced and regulated health insurance for low income earners. It was limited to individuals with an income less than 2000 Mark per year and guaranteed the insured person a 60% minimum income during sickness.[citation needed]

Function

Function of the statutory health insurance according to § 1 SGB V is to preserve, recreate or improve health of the insured person. According to § 27 SGB V this includes to "subdue the afflictions of illness".[citation needed]

All insured fundamentally have the same entitlement for benefits. The scope of benefits is regulated in SGB V ("social insurance bill five") and limited by § 1 SGB V. Benefits have to be adequate, appropriate and economic and shall not exceed the necessary for the insured.[citation needed]

Additional benefits can only be granted based on particular regulations based on formal law. These are e.g. additional service for the prevention of sickness, care at home, household support, rehabilitation etc.[citation needed]

Based on the principle of solidarity and compulsory membership, the calculation of fees differs from private health insurance in that it does not depend on personal health or health criteria like age or sex, but is connected to one's personal income by a fixed percentage. The aim is to cover the risk of high cost from illness that an individual can not bear alone.[citation needed]

Organisation

The German legislature has reduced the number of public health insurance organisations from 1209 in 1991 down to 124 in 2015.[citation needed]

The public health insurance organisations (Krankenkassen) are the Ersatzkassen (EK), Allgemeine Ortskrankenkassen (AOK), Betriebskrankenkassen (BKK), Innungskrankenkassen (IKK), Knappschaft (KBS), and Landwirtschaftliche Krankenkasse (LKK).[citation needed]

As long as a person has the right to choose his or her health insurance, he or she can join any insurance that is willing to include the individual.

The online encyclopedia Wikipedia has, since the late 2000s, served as a popular source for health information for both laypersons and, in many cases, health care practitioners. Health-related articles on Wikipedia are popularly accessed as results from search engines, which frequently deliver links to Wikipedia articles.[1] Independent assessments have been made of the number and demographics of people who seek health information on Wikipedia, the scope of health information on Wikipedia, and the quality of the information on Wikipedia.[2]

The English-language Wikipedia was estimated in 2014 to hold around 25,000 articles on health-related topics.[3] Across Wikipedia encyclopedias in all languages there were 155,000 health articles using 950,000 citations to sources and which collectively received 4.8 billion pageviews in 2013.[4] This amount of traffic makes Wikipedia one of the most consulted health resources in the world, or perhaps the most consulted resource.

Academic studies

A 2007 study examined a sample of Wikipedia pages about the most frequently performed surgical procedures in the United States, and found that 85.7% of them were appropriate for patients and that these articles had "a remarkably high level of internal validity".[5] However, the same study also raised concerns about Wikipedia's completeness, noting that only 62.9% of the articles examined were free of "critical omissions".[5]

A 2008 study reported that drug information on Wikipedia "has a more narrow scope, is less complete, and has more errors of omission" than did such information on the traditionally edited online database Medscape Drug Reference.[6]

A 2011 assessment of 50 medical articles on Wikipedia found that 56% of the references cited on these pages could be considered reputable, and that each entry contained 29 reputable sources on average.[7]

A 2011 study examined Wikipedia pages about five statins, and concluded that these pages did not contain incorrect or misleading information, but that they were often missing information about drug interactions and contraindications to use.[8]

Another 2011 study examining Wikipedia articles on the 20 most widely prescribed drugs found that seven of these articles did not have any references, and concluded that "Wikipedia does not provide consistently accurate, complete, and referenced medication information."[9]

An assessment of Wikipedia articles in 2012 on dietary supplements found that Wikipedia articles were "frequently incomplete, of variable quality, and sometimes inconsistent with reputable sources of information on these products."[10]

A 2013 review of nephrology content on Wikipedia found it to be "a comprehensive and fairly reliable medical resource for nephrology patients that is written at a college reading level".[11]

A 2013 scoping review published in the Journal of Medical Internet Research summarized the existing evidence about the use of wikis, Wikipedia and other collaborative writing applications in health care and found that the available research publications were observational reports rather than the primary research studies which would be necessary to begin drawing conclusions.[12]

A 2014 study that examined 97 Wikipedia articles about complementary and alternative medicine (CAM) found that 4% of them had attained "Good article" status, and that CAM articles on Wikipedia tended to be significantly shorter than those about conventional therapies.[13]

In May 2014 the The Journal of the American Osteopathic Association published an article which concluded that "Most Wikipedia articles for the 10 costliest conditions in the United States contain errors compared with standard peer-reviewed sources."[14] Following this paper, many other media sources reported that readers should not trust Wikipedia for medical information.[15] Wikipedia's contributors to its health content defended Wikipedia and criticized this study.[16]

A 2014 study found that when the FDA issues new safety warnings about drugs, in 41% of cases reviewed Wikipedia articles about those drugs were updated to give the new safety information within two weeks.[17] Another 23% of Wikipedia drug articles were updated to give this information within an average of about 40 days, but 36% of articles are not updated with this information within a year.[17]

A 2014 comparison between selected drug information from pharmacology textbooks and comparable information on the English-language and German-language Wikipedias found that the drug information in Wikipedia covers most of what is essential for undergraduate pharmacology studies and that it is accurate.[18]

The readability of Wikipedia's articles for epilepsy and Parkinson's disease was critiqued and found to be difficult to read.[19][20] Another study found that Wikipedia's information about neurological diseases was significantly more difficult to read than the information in the American Academy of Neurology's patient brochures, the Mayo Clinic's website, or MedlinePlus.[21] Another study reported that Wikipedia should not be used to learn about concepts related to pulmonology students.[22]

Other views

Wikipedia co-founder Jimmy Wales has said that lack of health information increases preventable deaths in emerging markets and that health information from Wikipedia can improve community health.[23] Wales presented the Wikipedia Zero project as a channel for delivering health information into places where people have difficulty accessing online information.[23]

People who promote alternative medicine have complained that Wikipedia negatively portrays holistic health treatments including energy medicine, Emotional Freedom Techniques, Thought Field Therapy and Tapas Acupressure Technique.[24] In response, Wales has stated, "If you can get your work published in respectable scientific journals – that is to say, if you can produce evidence through replicable scientific experiments, then Wikipedia will cover it appropriately."[24][25][26] Similar concerns have been raised regarding its coverage of homeopathy.[27]

As a result of public interest in the 2014 Ebola virus epidemic in West Africa, Wikipedia became a popular source of information on Ebola.[28] Doctors who were Wikipedia contributors said that Wikipedia's quality made it useful.[28]

Extent of usage

The majority of people in the United States use the internet as a source of health information.[29] One 2013 study suggested that 22% of healthcare searches online direct users to Wikipedia.[30]

Wikipedia was described in 2014 as "the leading single source of healthcare information for patients and healthcare professionals".[31] A study of a particular group of veterinary students found that the majority of these students sought and found medical information on Wikipedia.[32] Some doctors have described their use of Wikipedia as a "guilty secret".[33]

Wikipedia's health information has been described as "transforming how our next doctors learn medicine".[34] Various commentators in health education have said that Wikipedia is popular among medical students.[35][36]

Academic citations

Wikipedia has been inappropriately cited as an authoritative source in many health science journals.[37][38]

Impact on psychological tests

In 2009 a doctor and Wikipedia editor, James Heilman, incorporated public domain images of the Rorschach test into Wikipedia.[39] Psychologists complained that the increased public exposure to these tests devalued their clinical utility, and that public health was harmed as a result.[39]

Nature of contributors

A 2014 interview study found that around half of the editors of health-related content on the English-language Wikipedia are health care professionals, while the other half includes some medical students.[3] An author of this study wrote that this provides "reassurance about the reliability of the website".[3] The study also found that the "core editor community", who actively monitor and edit most health-related articles on the English-language Wikipedia, numbered around 300 people.[40] The study found that people who contribute on these topics do so for a variety of reasons, including a desire to better learn the subjects themselves, and a sense of both responsibility and enjoyment in improving others' access to health information.[40]

Usage of traffic statistics in health monitoring

Just as Google Flu Trends was able to correlate searches for flu to local outbreaks of flu, page views of Wikipedia articles on flu-related topics have been found to increase in populations experiencing the spread of flu,[41][42] and of other diseases such as dengue fever and tuberculosis.[43][44]

Projects to improve health information on Wikipedia

In 2009 the National Institutes of Health attempted a pilot project for integrating health information into Wikipedia.[45] In 2011, it was reported that Cancer Research UK had started a program whereby some of its staff would edit Wikipedia's cancer-related articles.[46]

The University of California, San Francisco has a program for encouraging students to contribute health content to Wikipedia.[47]

In response to studies showing that the majority of patients and providers use the Internet to find health information,[48][49] the Maternal and Child Health (MCH) Library developed a New Media Primer to increase the skills of health care providers in using social media to share information on public health.[50] A 2012 article from Children’s Hospital of Eastern Ontario described the development of a disease-specific primer for providers and patients guiding both to the highest quality and most reliable new media sites.

Private healthcare or private medicine is healthcare and medicine provided by entities other than the government. The term is generally used more in Europe and other countries which have publicly funded health care, to differentiate the arrangement from systems where private healthcare is the norm.

Ethical issues relating to private healthcare primarily concerns the argument that the seriously ill be entitled to spend money on saving their lives. On the other hand, private healthcare can sometimes be more efficient than public sector provision. Private operators may be more innovative in areas such as telemedicine. Due to the profit motive, they can be more productive. Public healthcare tends to be limited by the amount of tax that individuals are willing to pay.

Some would argue that private healthcare needs to be more carefully regulated to ensure that it achieves standards set by the state, predominantly regarding safety, value, and efficiency.

Forms of private healthcare in Europe

Charging patients or private insurers for work

Europeans in all countries are willing to pay a charge for some private healthcare, whether to avoid long queues, to access cosmetic surgery, or to avoid the perceived risk of infection in public-sector hospitals. This is not a small market. In Finland it is estimated that it is worth some €700m a year. In Greece, half the income of private hospitals is from one-off payments from patients. Maternity is a particularly large private market, as it is the demand for fertility both at home and abroad, where more than 18% of medical internet based searches are related to infertility conditions and treatment.[1] Healthcare tourism is also thriving within the EU, in which patients (mainly from the UK) travel to Eastern Europe for low-cost dental work. The particularly wealthy Russians and Saudi Arabians tend to go to private hospitals in Switzerland or Germany.

As most Europeans have access to public sector provision either through their mandatory social insurance fund or through taxes, private healthcare insurance remains a relatively small market, with levels typically in the range of 2%-8% of the population. Many consumers prefer to pay single fees as and when necessary. In addition, any occupational healthcare paid for by employers renders private healthcare insurance unnecessary. Nonetheless, around 10% of Germans have some form of private healthcare insurance which enables them to experience a slightly higher level of comfort during hospital stays. The most notable development in this area has been the Netherlands, which in 2005 moved to a system whereby all citizens are forced to take out private healthcare insurance rather than social insurance. This is being closely monitored by many European countries.

Occupational healthcare

In many European countries with a state-run national health service, employers are obliged to pay for some level of healthcare for their employees. This is the case in Romania, Poland and Finland, for instance, and one can find networks of small clinics in large cities in these countries. In other countries, such as the UK and Sweden, many employers are willing to pay for occupational healthcare for their workforce so that key workers can avoid delays in seeing a doctor when they are unwell. Naturally though, the occupational health department of a publicly funded hospital will provide a similar standard of healthcare to that provided for patients.

Health Administration or Healthcare Administration is the field relating to leadership, management, and administration of public health systems, health care systems, hospitals, and hospital networks. Health care administrators are considered health care professionals.

Terminology

Health systems management or health care systems management describes the leadership and general management of hospitals, hospital networks, and/or health care systems. In international use, the term refers to management at all levels.[1] In the United States, management of a single institution (e.g. a hospital) is also referred to as "Medical and health services management"[2] "Healthcare management" or Health Administration.

Health systems management ensures that specific outcomes are attained, that departments within a health facility are running smoothly, that the right people are in the right jobs, that people know what is expected of them, that resources are used efficiently and that all departments are working towards a common goal.

Hospital administrators

Hospital administrators are individuals or groups of people who act as the central point of control within hospitals. These individuals may be previous or current clinicians, or individuals with other backgrounds. There are two types of administrators, generalists and specialists. Generalists are individuals who are responsible for managing or helping to manage an entire facility. Specialists are individuals who are responsible for the efficient operations of a specific department such as policy analysis, finance, accounting, budgeting, human resources, or marketing.[3]

It was reported in September 2014, that the United States spends roughly $218 billion per year on hospital's administration costs, which is equivalent to 1.43 percent of the total U.S. economy. Hospital administration has grown as a percent of the U.S. economy from .9 percent in 2000 to 1.43 percent in 2012, according to Health Affairs. In 11 different countries, hospitals allocate approximately 12 percent of their budget toward administrative costs. In the United States, hospitals spend 25 percent on administrative costs.[4]

Training and Organizations

Associated Qualifications

Health care management is usually studied through healthcare administration[5] or healthcare management[6] programs in a business school or, in some institutions, in a school of public health.

Although many colleges and universities are offering a bachelor's degree in healthcare administration or human resources,[5] a master's degree is considered the "standard credential"[7] for most health administrators in the United States. Research and academic-based doctorate level degrees, such as the Doctor of Philosophy (PhD) in Health Administration and the Doctor of Health Administration (DHA) degree, prepare health care professionals to turn their clinical or administrative experiences into opportunities to develop new knowledge and practice, teach, shape public policy and/or lead complex organizations. There are multiple recognized degree types that are considered equivalent from the perspective of professional preparation.

The Commission on the Accreditation of Healthcare Management Education (CAHME) is the accrediting body overseeing master's-level programs in the United States and Canada on behalf of the United States Department of Education. It accredits several degree program types, including Master of Hospital Administration (MHA), of Health Services Administration (MHSA), of Business Administration in Hospital Management (MBA-HM), Master of Health Administration (MHA), Master of Public Health (MPH, MSPH, MSHPM), Master of Science (MS-HSM, MS-HA), and Master of Public Administration (MPA).

Professional Organizations

There are a variety of different professional associations related to health systems management, which can be subcategorized as either personal or institutional membership groups. Personal membership groups are joined by individuals, and typically have individual skills and career development as their focus. Larger personal membership groups include the American College of Healthcare Executives, the Healthcare Financial Management Association, and the Healthcare Information and Management Systems Society. Institutional membership groups are joined by organizations; whereas they typically focus on organizational effectiveness, and may also include data-sharing agreements and other medical related or administrative practice sharing vehicles for member organizations. Prominent examples include the American Hospital Association and the University Healthsystems Consortium.

History

Early hospital administrators were called patient directors or superintendents. At the time, many were nurses who had taken on administrative responsibilities. Over half of the members of the American Hospital Association were graduate nurses in 1916. Other superintendents were medical doctors, laymen and members of the clergy. In the United States, the first degree granting program in the United States was established at Marquette University in Milwaukee, Wisconsin. By 1927, the first two students received their degrees. The original idea is credited to Father Moulinier, associated with the Catholic Hospital Association.[8]The first modern health systems management program was established in 1934 at the University of Chicago.[9] At the time, programs were completed in two years – one year of formal graduate study and one year of practicing internship. In 1958, the Sloan program at Cornell University began offering a special program requiring two years of formal study,[10] which remains the dominant structure in the United States and Canada today (see also "Academic Preparation").

Health systems management has been described as a "hidden" health profession[11] because of the relatively low-profile role managers take in health systems, in comparison to direct-care professions such as nursing and medicine. However the visibility of the management profession within healthcare has been rising in recent years, due largely to the widespread problems developed countries are having in balancing cost, access, and quality in their hospitals and health systems.[12]

See also

American College of Healthcare Executives

Master of Health Administration

Nosokinetics

Upsilon Phi Delta