National Health Systems of the World: The Issues - Vol. 2

National Health Systems of the World: The Issues - Vol. 2

National Health Systems of the World: The Issues - Vol. 2

National Health Systems of the World: The Issues - Vol. 2


This is Volume II of the comprehensive review of national health systems of the world presented in Volume I. In that volume, the author analysed the organization, financing, management, and delivery of health services in 68 countries at diverse levels of economic development and political ideology. In Volume II, the principal issues in health systems across countries are examined. The issues are categorized according to the several components by which national health systems may be analysed. They include such issues as the role of traditional healers, the scope of Ministries of Health, Social Security financing, commercial health insurance, methods of cost-containment, strategies of planning, legislation on health promotion, concepts of primary health care, control of sexually-transmitted diseases, emergency medical services, and many other controversial topics. The elucidation of these issues is designed not to provide answers, but to provoke discussion.


The reach of the physician has been greatly extended over the years by the training of a wide variety of other health personnel. Strictly speaking, most of these personnel perform their functions under the general supervision of or according to orders issued by the physician. In practice, however, these associated health personnel have developed a proper scope of functions of their own, and a great deal of their work is carried out quite independently of the physician. The most abundant category of health personnel is the nurse, who plays a major role in the health system of nearly all countries. Often closely associated with the nurse, and oriented especially to pregnancy and childbirth, is the midwife.

In addition to nurses and midwives, who may have several levels of training, virtually all health systems have pharmacists (sometimes called chemists) with specialized knowledge of drugs. For analysis of blood, urine, and many other products of human life, there are diverse types of laboratory technicians or technologists. Many modalities of rehabilitation are the special skill of physical therapists and related personnel. A general health worker, who under certain circumstances may replace the physician, and who receives a relatively short period of training, exists in many countries. These workers, designated by different terms in various countries, are perhaps most commonly known as medical assistants. In recent times the term "community health worker" has come to be widely used for even more briefly trained personnel. Regarding dietary matters, there is the dietician and, on a more advanced level, the nutritionist. The written record of a patient's status may be handled by the medical record librarian. The relationships of patients with their families and the total social environment are facilitated by social workers in more developed societies.

To handle complex types of diagnostic or therapeutic equipment, there are still other types of health personnel, especially in highly industrialized countries. We cannot consider them all, but will concentrate on the broad fields of nursing, pharmacy, medical technology, dental personnel, medical assistants, and community health workers in this chapter.


The modern professional nurse has evolved from an untrained person, usually a woman, who took care of patients in bed. Over the years, many types and levels of nurse have developed. If all of these are counted, nursing is usually the most populous category of health personnel in a country.

Historical Background

In ancient Greece, the Aesculapian temples, to which the sick went for prayers, might be considered the antecedents of hospitals. In these structures there were priests or assistant priests to take care of the sick patients. In the Roman empire, there were also valetudinaria for the care of injured soldiers and slaves. The caretakers were usually male slaves.

From the earliest times, however, in a family's home, the women took care of sick relatives. When the Christian Church showed its charity and mercy by building structures for the sick poor, it chose women close to the . . .

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