Healing, medical care, and health service organizations

This paper reviews the reasons for disappointing health results from U.S. medical care, and prescribes values for health service organizations (HSOs) that will provide a foundation for better medicine. Although the United States spends more money that any other country in the world on medical care, it ranks twenty-sixth in major indicators of population health. One reason for this is inequality in income distribution and other issues relating to social justice. Lack of access to medical care and the poor quality of care that is often rendered may also damage population health. A key component in the movement for improved medical outcomes is the concept of healing care in contrast to curing disease. Patient-centered approaches such as those advocated by the Institute of Medicine to improve medical quality and reduce medical error may provide a bridge to a healing environment in HSOs. A research program on the optimal healing environment must study issues of cost, access, and quality to support successful, broad-based integration of such programs in HSOs. Key research questions on these topics are proposed.