The state of complete physical, mental and social well-being and not merely the absence of disease or physical disability. [WHO]
Public health establishments or officials responsible for a particular geographic area: province, region, country. Health authorities differ from public health care providers in that their mandate is not to offer health services, but, generally, to promote health and to regulate the health sector. [ref. 144]
A health service delivered by the staff of a health facility. Such services may be dispensed in the context of basic health care, specialist treatment, home care, outpatient care, in-patient care, the provision of medicines, etc. [ref. 144]
See also: medical care benefit
An establishment or institution engaged in the field of health as a provider of health care to individuals: health centre, dispensary, doctor's office, hospital, etc. [ref. 144]
Synonym: medical facility
The grouping together of a certain number of health care providers within a particular region in order to increase the effectiveness of health care. Coordination among the members of the network allows for improving the transfer of information, in particular, as regards patients' medical records, and consequently, for providing more effective treatment for sick persons. [ref. 144]
A person or a health facility that provides health care to a patient.
Examples: Doctors, pharmacists, surgeons, midwives, nurses, health centres, district hospitals, regional hospitals, national hospitals, dispensaries, traditional practitioners, etc. [ref. 144]
The set of health services or health care providers available for a given population. [ref. 144]
A form of credit intended to finance health care expenses whose conditions of grant and repayment deadlines often differ from those of other forms of credit. An organization setting up a health micro-insurance scheme may also set up a health credit mechanism in order to provide financing for health costs either not covered by the scheme or whose coverage is subject to a maximum. It may also set up such a mechanism in order to enable insured persons to pre-finance health expenses in the absence of a third-party payment. [ref. 144]
An agreement concluded between a health micro-insurance scheme and an individual (member) or group of individuals (enterprise, trade union) in which the scheme agrees to cover prescribed health expenses incurred by the persons concerned in exchange for the regular payment of a premium. Health insurance contracts are clearly defined, limited in time, renewable and revocable. Only health micro-insurance schemes that do not provide for the participation of insured persons in the scheme's management conclude contracts with their members: schemes managed by health care providers, commercial insurance companies. Conversely, mutual health organizations do not conclude contracts with their members. Their relations with members are governed by the rights and obligations set forth in the statutes and internal rules of the scheme. [ref. 144]
An insurance scheme – often set up by a civil society organization – whose purpose is to provide health insurance coverage to persons excluded from formal systems of social protection – mainly informal economy workers and their families. The term "micro" does not refer so much to the size of these schemes as to their social moorings. Even if such schemes are usually small in size, there are some, notably in Asia, that extend coverage to more than 100,000 persons. Others participate in networks or unions in which numerous schemes are linked together to form vast organizations. The term "insurance" refers to the financial mechanism utilized, which consists of pooling the risks and resources of an entire group in order to guarantee protection to all members against the financial consequences of health risks determined on a mutual basis. [ref. 7573]
The organization of health services on a national scale, generally including several levels. [ref. 144]
See also: level of health infrastructure (or level of the health pyramid), compulsory referral
Refers to contingencies that affect the health of individuals (illness, maternity). A distinction is made between major and minor risks. Major risks are those that entail considerable expense, such as hospitalizations, dystocic pregnancies, surgical operations, etc. Such contingencies are rare and have a low probability of occurrence. Minor risks are those that entail more moderate expense, such as consultation with a general practitioner or the purchase of generic drugs. They are much more commonplace and have a high probability of occurrence. [ref. 144]
Synonym: risk of illness
A set of mechanisms that enable members to put aside funds in anticipation of a future health expense or to pay for future health care at a time when they have sufficient income available.
Examples: Individual health savings, subscription card, anticipated global payment (prepayment) for certain services, notably, mother and child health care.
These mechanisms can be worthwhile for persons with irregular incomes who, for that reason, are likely to be confronted with health expenses at a time when they lack sufficient resources to meet them. In the case of sickness or maternity, such persons would be able to utilize health services only up to the amount that they had saved or "prepaid". Risk management in such cases is individualized, and, contrary to an insurance plan, there is no pooling of resources to protect against risks. A health savings scheme may, however, be used to supplement an insurance plan. It may be applied to minor risks, for example, whereas the insurance plan is used to cover major risks. [ref. 144]
A medical service provided by a health care worker (doctor, nurse, pharmacist, etc.) and "consumed" by a patient. Health micro-insurance schemes may cover individual health services or clusters of health services, provide flat-rate benefits per episode of illness, etc.
Examples of health services: medical consultations, biological analyses, "pharmaceuticals" (i.e. the provision of prescription medicines), vaginal deliveries, surgical operations. [ref. 144]
Refers to health services delivered to the patient's residence. In some countries, doctors or nurses make home visits; however, fees for home care are higher in order to compensate for travel expenses. [ref. 144]
Treatment provided during the hospitalization of a patient, that is, during a hospital stay including at least one night. [ref. 144]