出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/05/05 01:42:16」(JST)
Primary care is the day-to-day health care given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a health care system, and coordinates other specialist care that the patient may need.[1][2][3] Such a professional can be a primary care physician (general practitioner or family physician), a nurse practitioner (adult-gerontology nurse practitioner, family nurse practitioner, or pediatric nurse practitioner), a behavioral care provider, a pharmacist, a physician assistant, a registered nurse (such as in the United Kingdom), a clinical officer (such as in parts of Africa), or an Ayurvedic or other traditional medicine professional (such as in parts of Asia). Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.
The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary health care strategy. 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, and patients with all manner of acute and chronic physical, mental and social health issues, including multiple chronic diseases. Consequently, a primary care practitioner must possess a wide breadth of knowledge in many areas. Continuity is a key characteristic of primary care, as patients usually prefer to consult the same practitioner for routine check-ups and preventive care, health education, and every time they require an initial consultation about a new health problem. Collaboration among providers is a desirable characteristic of primary care.
The International Classification of Primary Care (ICPC) is a standardized tool for understanding and analyzing information on interventions in primary care by the reason for the patient visit.[4] Common chronic illnesses usually treated in primary care may include, for example: hypertension, angina, diabetes, asthma, COPD, depression and anxiety, back pain, arthritis or thyroid dysfunction. Primary care also includes many basic maternal and child health care services, such as family planning services and vaccinations.
In context of global population ageing, with increasing numbers of older adults at greater risk of chonic non-communicable diseases, rapidly increasing demand for primary care services is expected around the world, in both developed and developing countries.[5][6]
In Canada, access to primary and other health care services are guaranteed for all citizens through the Canada Health Act.
In Nigeria, health care is a concurrent responsibility of three tiers of government. Local governments focus on the delivery of primary care (e.g. through a system of dispensaries), state governments manage the various general hospitals (secondary care), while the federal government's role is mostly limited to coordinating the affairs of the Federal Medical Centres and university teaching hospitals (tertiary care).
A 2009 report by the New England Healthcare Institute determined that an increased demand on primary care by older, sicker patients and decreased supply of primary care practitioners has led to a crisis in primary care delivery. The research identified a set of innovations that could enhance the quality, efficiency and effectiveness of primary care in the United States.[6]
On March 23, 2010 President Obama signed the Patient Protection and Affordable Care Act (ACA) into law. The law is expected to expand health insurance coverage by 32 million people by 2016 and 34 million people by 2021.[7] The success of the expansion of health insurance under the ACA in large measure depends on the availability of primary care physicians. Unfortunately, The ACA has drastically exacerbated the projected deficit of primary care physicians needed to ensure care for insured Americans. According to the Association of American Medical Colleges (AAMC) without the ACA, the United States would have been short roughly 64,000 physicians by 2020; with the implementation of the ACA, it will be 91,000 physicians short. According to the AAMC's November 2009 physician work force report, nationally, the rate of physicians providing primary care is 79.4 patients per 100,000 residents.[7]
Primary health care results in better health outcomes, reduced health disparities and lower spending, including on avoidable emergency room visits and hospital care. With that being said, primary care physicians are an important component in ensuring that the healthcare system as a whole is sustainable. However, despite their importance to the health care system, the primary care position has suffered in terms of its prestige in part due to the differences in salary when compared to doctors that decide to specialize. In a 2010 national study of physician wages conducted by the UC Davis Health System found that specialists are paid as much as 52 percent more than primary care physicians, even though primary care physicians see far more patients.[8]
Primary care physicians earn $60.48 per hour; specialists on average earn $88.34.[8] A follow up study conducted by the UC Davis Health System found that earnings over the course of the careers of primary care physicians averaged as much as $2.8 million less than the earnings of their specialist colleagues.[9] This discrepancy in pay has potentially made primary care a less attractive choice for medical school graduates. In 2011, about 17,000 doctors graduated from American medical schools and only 7 percent of graduates chose a career in primary care.[10] The average age of a primary care physician in the United States is 47 years old, and one quarter of all primary care physicians are nearing retirement. [11] Fifty years ago roughly half of the physicians in America practiced primary care; today, fewer than one third of them do.
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The National Health Service or NHS is the Publicly-funded health care in England (though the term is also used to refer to the four national health services in the UK, collectively). The NHS provides healthcare to anyone normally resident in the United Kingdom with most services free at the point of use for the patient though there are charges associated with eye tests, dental care, prescriptions, and many aspects of personal care. The NHS has agreed a formal NHS Constitution for England which sets out the legal rights and responsibilities of the NHS, its staff, and users of the service and makes additional non-binding pledges regarding many key aspects of its operations.<ref>http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093419 NHS Constitution for England. Department of Health website</ref>
The NHS provides the majority of healthcare in England, including primary care, in-patient care, long-term healthcare, ophthalmology and dentistry. The National Health Service Act 1946 came into effect on 5 July 1948. Private health care has continued parallel to the NHS, paid for largely by private insurance: it is used by about 8% of the population, generally as an add-on to NHS services. In the first decade of the 21st century the private sector started to be increasingly used by the NHS to increase capacity. According to the British Medical Association a large proportion of the public opposed this move.<ref name="BMA 2007 survey">テンプレート:cite web</ref>.
The NHS is largely funded from general taxation (including a proportion from National Insurance payments)<ref>テンプレート:cite web</ref>. The UK government department responsible for the NHS is the Department of Health (United Kingdom), headed by the Secretary of State for Health. Most of the expenditure of The Department of Health (￡98.7 billion in 2008-9<ref name="budget2008">テンプレート:cite web</ref>) is spent on the NHS.