Health Services Research: A Working Model

Abstract Studies of the nature and effectiveness of health services often limit themselves to components of the system without considering all the pertinent variables that affect outcome of health care. Health-services research, however, could use a conceptual model that recognizes the four determinants of health status: the genetic makeup of patients, their behavior, medical practice and the environment. The components of medical practice, in turn, are structural (e.g., personnel, facilities, organization and financing) and functional (e.g., problem recognition, diagnosis and therapy). The interaction of the functional aspects of medical practice and of the behavior of patients constitutes the process of care. A formulation of health-services research along these lines permits an integrated view of structure, process and outcome, as well as taking into account physician-patient interaction. (N Engl J Med 289:132–136, 1973)